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a� SAN JOAQUIN COUNTY n <br /> ENVIRONMENTAL HEALTH DEPARTMENT (n�� <br /> <I ©1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> x .��• Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd SAN 2 <br /> • � 1 202 <br /> 'ENVIRpNMENT <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) PERMITjSER�/C SETH <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 /> CFO Business Name: CFO Owner N me: <br /> P_e+ W�P_� c)K co• Sn ri Mt <br /> CFO Address: CFO City: CFO ZIP: <br /> a r. n %20 9 <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. V ❑ <br /> 3. Additional storage used for the CFO will be within the home. El," ❑ <br /> a. If YES, is the room used exclusively for storage? 91' ❑ <br /> b. Specify the rooms)that will be used for storage? 64G LL en Poyt 4-e <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. [� ❑ <br /> Zoning Requirements: Yes No <br /> 5. 1 have complied with the applicable zoning requirements for the CFO. 5K ❑ <br /> Employee and Training Requirements: Yes No <br /> 6. Have all persons preparing or packaging CFO products completed the CDPH food 5�/ ❑ <br /> processor course? <br /> a. If YES, copies of certificates are attached. E�K ❑ <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 ❑ <br /> household members are not included.) <br /> Sanitation Requirements: Yes No <br /> 8. Kitchen equipment and utensils used to produce CFO products are clean and [9" ❑ <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 sanitized before each [� ❑ <br /> use. <br /> 10. All food preparation and food and equipment storage areas shall be maintained free of Q/ ❑ <br /> rodents and insects. <br /> EHD 16-26 12/27/2012 1 CFO CLASS A CHECKLIST <br />