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r <br /> Food Preparation Requirements(includes packaging and handling): Yes No <br /> 11. Hand washing is required immediately prior to handling foods and after engaging in / El <br /> activity that contaminates the hands such as after using the toilet, coughing or ❑ <br /> sneezing,eating or smoking. <br /> 12. Warm water, hand soap and clean towels are available for hand washing. ❑ <br /> 13. All food ingredients used in the CFO products are from an approved source. , ,JEl( <br /> 14. Potable water shall be used for hand washing, ware washing and as an ingredient. p(� ❑ <br /> 15. Is your water source a private well? ❑ <br /> a.If YES, have you completed testing for bacteria and nitrate? ❑ ❑ <br /> 16. Is your water source a public water system or community services district? II [ ❑ <br /> a.if YES,what is the name of the system or district? 0,1V b-r STD_CMN <br /> During the preparation, packaging or handling of CFO products: Yes No <br /> 17. Domestic activities such as family meal preparation,dishwashing,clothes washing or11ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <br /> 18. Infants, small children, or pets are excluded from the kitchen. 2 ❑ <br /> 19. Smoking is excluded. [' ❑ <br /> 20. Any person with a contagious illness shall refrain from work in the CFO. d ❑ <br /> Labeling Requirements: Yes No <br /> 21. A copy of the label has been submitted to this Department for review and approval. ❑ <br /> 22. 1 have attached a sample label. ❑ <br /> By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 <br /> (Gatto), as it pertains to a"Class A"Cottage Food Operation. Prior to making any changes, I acknowledge that 1 must <br /> notify San Joaquin County Environmental Health Department of any intended changes to the above statement. <br /> Cottage Food Operator Checklist completed and submitted by: <br /> G D e, .bzs y- - rte <br /> '!Ioarure U PHM Name Date <br /> EHD 16-26 12/27/2012 2 CFO CLASS A CHECKLIST <br />