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SANSl0A0U1N Environmental Health Department <br /> �.. <br /> —COUNTY— <br /> .. <br /> 'Okjnobsr� Grrntnras grmrr fia•rn <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br /> SELF CERTIFICATION CHECKLIST <br /> the follows gmgvhmam3 am 0-Mled fn the Collage Food Opemlbas(CFOJ reputations and aro pmNtlod es minGnum ttarkards o/hoalU <br /> and safety lar Ne pmpemlion o(eppmved mtlepe foods N the harm. <br /> CFO Business Name: FO Owmr Name: <br /> / <br /> ria rill �/rh m l i i caw <br /> CFO me. CFO CITY - CF021P: <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides 03, ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. 0 ❑ <br /> 3. Additional storage used for the CFO will be within the home. L ❑ <br /> a. If YES,Is the room used exclusively for storage? gal ❑ <br /> b. Specify the room(s)that will be used for storage? —/JAeL <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. B9 ❑ <br /> Zoning Requirements: Yes No <br /> 5. 1 have complied with the applicable zoning requirements for the CFO. L>-' ❑ <br /> Employee and Training Requirements: Yes No <br /> 6. Have all persons preparing or packaging CFO products Completed the COPH food V ❑ 9R/ <br /> prooessor course? <br /> a. If YES,copies of certtficales are attached. LI ❑ <br /> b. If NO,complete course within 3 months of CFO registration. [tom ❑ <br /> 7. The CFO has no more than 1 full-time equivalent employee?(Immediate family or Q/ ❑ <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 ❑ <br /> maintained in a good state of repair. - <br /> 9. Al 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 I?' ❑ <br /> use. <br /> 10.All food preparation and food and equipment storage areas shall be maintained free of ❑ <br /> rodents and Insects, <br /> 1868 E.Hazelton Avenue I Stockton,California 95205 1 T 209 468-34201 F 209 464-0138 1 www.stcehd.com <br />