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Cal Food Preparation Requirements (includes packaging and handling): Yes No 11. Hand washing is required immediately!priorto handling foods and after engaging in .tIi 3A5 wt ffiit(.'r- � , any activity that contaminates the hands such as after using the toilet, coughing or •„1/f#` sneezing, eating or smoking. 12. Warm water, hand soap and clean towels are available for hand washing. ❑ 13. All food ingredients used in the CFO products are from an approved source. ❑ �� p 14. Potable water shall be used for hand washing, ware washing and as an ingredient. YJ� 15. Is your water source a private well? a.If YES, have you completed testing for bacteria and nitrate? ❑ ❑ J' 16. Is our water source a public waters stem or community services district? ❑ G 8 y p Y Q1 a.If YES, what is the name of the system or district? Yes No During the preparation, packaging or handling of CFO.products: 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or 9 ❑ ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. 18. Infants, small children, or pets are excluded from the kitchen. UK ❑ 19. Smoking is excluded- [Z ❑ 20. Any person with a contagious illness shall refrain from-work in the CFO. ® ❑ Labeling Requirements: Yes No 21. A copy of the label has been submitted to this Department for review and approval. tS ❑ 22. 1 have attached a sample label. Q ❑ 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. Co ge Food Operator Checklist completed and submitted by: gig-nature Print Name Date EHD 16-26 12/2712012 2 CFO CLASS A CHECKLIST