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Website (If applicable): □"Class B" (Direct & Indirect Sales) $486 2. Prohibited Items: 4. Products: Please check the items you will be preparing and/or selling. □ Dried Pasta □ □ Baked Goods Honey □□ Dry Baking Mixes □□ VinegarCandyMustard □□ Waffle Cones □Dried Grain MixesChurros □□□□Flat Icing □□ Jams/Jellies**□□ Herb/Spice Blends PizzelesDried Mole Paste □□□ Fruit Tamales/PiesFruit Empanadas □□ Dried Fruit□□ Seasoning Salt Trail Mix/ Dried FruitGranola/Cereals □ Candied Apples □□Cotton Candy i CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 Buttercream Frosting/lcing* Buttercream Fondant/Gumpaste* Nut Mixes/Nut Butters Salted Caramel/Fudge Popcorn/ Popcorn Balls Ground Chocolate San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/EHD 1. Categories: E£] "Class A" (Direct Sales Only) $186 Fried or Baked □ Donuts and Waffles Marshmallows/ □ Marshmallow Bars* 3. “Class A” Self Certification Checklist: □ Checklist completed (“Class A” CFOs Only) 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. □ Fruit Butter** Date: \ \ CFO Zip: COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM (CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) daiH bouiiK / j CFO Business Name: C Xo Owner Name: £ uw - IS ^^<2 f l-Uitzv/k Of- ____________ CFO Physical Address: CFO City: _________ Telephone: