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c>B)xq. FRtC’Ooiqyft “Class B” (Direct & Indirect Sales) $486□ os growth that could be a cause of food-borne illness. 3. □□ Honey□ Dried PastaBaked Goods □ Vinegar□ Mustard□ Dry Baking Mixes□Candy □ Fruit Butter**□ Dried Grain Mixes□ Waffle ConesChurros □Flat Icing □ Jams/Jellies**□ Pizzeles□ Herb/Spice Blends□Dried Mole Paste □□ Fruit Tamales/Pies□Fruit Empanadas □ Dried Fruit□ Trail Mix/ Dried Fruit□ Seasoning SaltGranola/Cereals □ Candied Apples□Cotton Candy CFO REG/PERMFFTING FORM1EHD 16-27 6/29/2023 Buttercream Frosting/lcing* Buttercream Fondant/Gumpaste* Salted Caramel/Fudge Nut Mixes/Nut Butters Ground Chocolate Popcorn/ Popcorn Balls □ Date: •5-15-2.0 CFO Zip’ 1. Categories: “Class A" (Direct Sales Only) $186 “Class A” Self Certification Checklist: □ Checklist completed (“Class A" CFOs Only) “non-potentially hazardous” areOnly foods that are defined as Fried or Baked □ Donuts and Waffles Marshmallows/ [Tj Marshmallow Bars* CFO Business Name CFO Physical Address tl 55 W A-yt z? M Website (If applicable) San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwjjgov.orq/EHD COTTAGE FOOD OPERATIONS (CFO) REGISTRATION/PERMITTING FORM ^CALIFORNIA HOMEMADE FOOD ACT AB 1616 (GATTO)) Owner Name CFO City Telephone. 2 Prohibited Items: Initial if you agree to abide by the following: Foods containing cream, custard, or meat fillings are potentially hazardous and are NOT ALLOWED. ‘ — approved for preparation by a Cottage food Operation. These foods include items that do not require refrigeration to keep them safe from bactenal 4. Products: Please check the items you will be preparing and/or selling.