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Food Preparation Requirements (includes packaging and handling): Yes No 11. Hand washing is required immediately prior to handling foods and after engaging in �y activity that contaminates the hands such as after using the toilet, coughing or 12 ❑ s, zing, eating or smoking. 12. Wir,,i water, nand soap and clean towels are available for hand washing. ® ❑ 13. All food ingrec:-r.s us. 1 in the CFO products are from an approved source. W ❑ 14. Potable water shall be , Pc; ,. "qnd washing, ware washing and as an ingredient. 5� ❑ 15. Is your water source a private v.ill? ❑ IR a.If YES, have you completed test;ng i.•bacteria and nitrate? v4 k r$-'$ 16. Is your water source a public water system or t,-mmunity services district? [ ❑ a.If YES, what is the name of the system or district? During the preparation, packaging or handling of CFO products: Yes No 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or 51 ❑ ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. 18. Infants, small children, or pets are excluded from the kitchen. ❑ 19. Smoking is excluded. IR ❑ 20. Any person with a contagious illness shall refrain from work in the CFO. r] ❑ Labeling Requirements: Yes No 21. A copy of the label has been submitted to this Department for review and approval. 9 ❑ 22. 1 have attached a sample label. 9 ❑ By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 (Gatto), as it pertains to a "Class A"Cottage Food Operation. Prior to making any changes, I acknowledge that I must notify San Joaquin County Environmental Health Department of any intended changes to the above statement. Cottage Food Operator Checklist completed and submitted by: Signa re Print Name D to 1 kuJA<— EHD 16-26 12/27/2012 2 CFO CLASS A CHECKLIST