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c �h SAN JOAQUIN COUNTY <br /> O�S <br /> ?ai ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �. Teiephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sicov.org/ehd <br /> c,k dt' <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br /> SELF CERTIFICATION CHECKLIST <br /> The following requirements are outlined in the Cottage Food Operations(CFO)regulations and are provided as minimum standards <br /> of health and safety for the preparation of approved cottage foods in the home. <br /> CFQ Business Name: / CFO Owner Name: <br /> Z&wg <br /> 5klk?Aa- G <br /> CFO Address: CFO City: CFO ZIP: <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides 0 ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. ❑ ❑ <br /> 3. Additional storage used for the CFO will be within the home. ❑ <br /> a. If YES, is the room used exclusively for storage? ❑ <br /> b. Specify the room(s)that will be used for storage? <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. [ El <br /> Yes No <br /> Zoning Requirements: <br /> F5. I have complied with the applicable zoning requirements for the CFO. ❑ <br /> Employee and Training Requirements: <br /> Yes No <br /> 6. Have all persons preparing or packaging CFO products completed the CDPH food 0 <br /> processor course? <br /> El <br /> a. If YES, copies of certificates are attached. <br /> b. If NO, complete course within 3 months of CFO registration. ❑ <br /> 7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or �2 ❑ <br /> household members are not included.) <br /> Yes No <br /> Sanitation Requirements: <br /> 8�Kitchen quipment and utensils used to produce CFO products are clean and ❑ ❑ <br /> maintained in a good state of repair. <br /> 9. All food contact surfaces, equipment, and utensils used for the preparation, packaging, <br /> or handling of any CFO products shall be washed, rinsed, and 5anitized before each ❑ <br /> use. <br /> �11 and la�uipment 5tOfa9e Meas Shall be maintained free of <br /> ro mfg nn� ►rlgpc . <br /> EHO 16-2012/2712012 1 CFO CLASS A CH[CKLIS1 <br /> ■ <br /> l,-d 9Z L L6££60Z tslleioadS aaullPaB aul e05:01- '61. LO�(e M0 <br />