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Owner Name: <br />CFO City: <br />(gM) W?) -7//^ <br />“Class B" (Direct & Indirect Sales) $486 <br />2. Prohibited Items: <br />4. Products: <br />Please check the items you will be preparing and/or selling. <br /> Dried Pasta HoneyBaked Goods <br /> VinegarDry Baking Mixes MustardCandy <br /> Fruit Butter* Waffle Cones Dried Grain MixesChurros <br />Flat Icing <br /> Jams/Jellies**0 Herb/Spice Blends PizzelesDried Mole Paste <br /> Fruit Tamales/PiesFruit Empanadas <br />Trail Mix/ Dried Fruit Dried Fruit Seasoning SaltGranola/Cereals <br />0 Candied ApplesCotton Candy <br />1 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />Buttercream <br />Frosting/lcing* <br />COTTAGE FOOD OPERATIONS (CFO) <br />REGISTRATION/PERMITTING FORM <br />(CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) <br />Buttercream <br />Fondant/Gumpaste* <br />Nut Mixes/Nut <br />Butters <br />Salted <br />Caramel/Fudge <br />Popcorn/ <br />Popcorn Balls <br />Ground <br />Chocolate <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/EHD <br />1. Categories: <br />[3 “Class A” (Direct Sales Only) $186 <br />CFO Business Name: <br />CFO Physical Address: <br />ITSW XrH)VUC<IP Drivit <br />Website (If applicable): <br />Fried or Baked <br /> Donuts and <br />Waffles <br />Marshmallows/ <br />O Marshmallow <br />Bars* <br />3. “Class A” Self Certification Checklist: <br />0' Checklist completed (“Class A” CFOs Only) <br />CFO Zip: <br />MunjCCd <br />Telephone: <br />Initial if you agree to abide by the following: <br />Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. <br />Only foods that are defined as "non-potentially hazardous” are approved for preparation by a Cottage Food <br />Operation. These foods include items that do not reguire refrigeration to keep them safe from bacterial <br />growth that could be a cause of food-borne illness.