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�"'�'" SAN JOAQUIN COUNTY <br /> .z ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c3i.... � ;v• Telephone: (209) 468-3420 Fax:(209)464-0138 Web: www.sioov.org/ehd <br /> C*'N� <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <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 Name: <br /> 0;4.1C-f to M1i -A -f ILMJfZ C-1(.pRiA MWIN I <br /> CFO Address: CFO City:. CFO ZIP: <br /> 435 w miftA` wTE .lK r4cogMNf0kSCICA 95391 <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides 0 ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. ❑ <br /> 3. Additional storage used for the CFO will be within the home. ® ❑ <br /> a. If YES, is the room used exclusively for storage? ® ❑ <br /> b. Specify the room(s)that will be used for storage? ?AHTV-t( <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. ® ❑ <br /> Employee and Training Requirements: Yes No <br /> 6. Have all persons preparing or packaging CFO products completed the CDPH food ® ❑ <br /> processor course? S041kfE W F1Gfl"0/ 11b30 <br /> a. If YES, copies of certificates are attached. 5'rp 'q/3u/Zo2f ❑ ❑ <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 /> B. Kitchen equipment and utensils used to produce CFO products are clean and ❑ <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 <br /> rodents and insects. <br /> EHD 16-261227/2012 1 CFO CLASS A CHECKLIST <br />