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PrP O'o'Z Cl O Biisiwss Name □‘Class B” (Direct & Indirect Sales) S486 2 Prohibited Items: 3. 4. Products: Please check the items you will be preparing and/or selling £□ Dried Pasta □ Honey □Baked Goods □□ Dry Baking Mixes□MustardCandy □ Dried Gram Mixes□ Waffle Cones □ Fruit Butter”□Churros □ Flat Icing□□!S □ Pizzeles□ Herb/Spice Blends□□ Jams/Jellies’’Dried Mole Paste □□ Fruit Tarnales/Pies□Fruit Empanadas □ Trail Mix/ Dried Fruit□ Seasoning Salt □ Dried Fruit□Granola/Cereals □□ Candied Apples□Cotton Candy cr O RtG/PE RMII I ING I- OHMLHD 16 2 7 6/29/2023 1. Categories: "Class A" (Direct Sales Only) SI86 Butter cream Frostrng/lcing’ COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) Buttercream Fondant/Gumpaste’ Nut Mixes/Nut Butlers Salted Caramel/Fudge Ground Chocolate San Joaquin County Environmfntai He ai th Di partment 1868 I as! Hazelton Avenue, Stockton. CA 95205-6232 Telephone (209) 468 3420 Fax. (209) 464 0138 Web: www Siaov.org/EHD (\euu- Owner Name crocity Dale ^24?. CfO ZipCf O Physical Address Website (if applicable) I “Class A” Self Certification Checklist: E Checklist completed (“Class A' CFOs Only) Popcorn/ Popcorn Balls □ Vinegar Fried or Baked □ Donuts and Waffles Marshmallows/ 0 Marshmallow Bars’ I elephone Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED Only foods that are defined as “non-potentially hazardous" are approved for preparation by a Cottage Food Operation These foods include items that do not require refrigeration to keep them safe from bacterial growth that could be a cause of food-borne illness.