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SAN JOAQUIN COUNTY <br /> Z. 4: <br /> 7 ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br /> SELF CERTIFICATION CHECKLIST <br /> The foiloWing requirements are outlined in the Cottage Food Operations(CFO)regulations and are provided as minimum standards <br /> of health and safety forthe preparation of approved collage foods in the home. <br /> CFO Bu7M�W <br /> me: CFO Owner Name: <br /> CFO AdCFO City.I 1 \_ DQ �- CFO ZIP:+ p'Yt'�(A_ ktY�0..Ji�- �j��n lkasS"e_. +53T*) <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides [r ❑ <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. \'P—S LTJ <br /> a. If YES, is the room used exclusively for storage? <br /> �(`(1 ❑ ❑ <br /> b. Specify the room(s)that will be used for storage? <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. E✓j ❑ <br /> Zoning Requirements: <br /> Yes No <br /> 5. 1 have Complied with the applicable zoning requirements for the CFO. ❑ <br /> Employee and Training Requirements: <br /> Yes No <br /> Have all persons preparing or packaging CFO products completed the CDPH food ❑ <br /> e <br /> 6. procssor course? <br /> ?a. If YES, copies of certificates are attached. El E-1b. If NO, complete course within 3 months of CFO registration. F-10 <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 and7of , <br /> maintained in a good state of repair.9. All food contact surfaces, equipment,and utensils used for the preparation, packagor handling of any CFO products shall be washed, rinsed, and sanitized before eacuse. <br /> 10. All food preparation and food and equipment storage areas shall be maintained freeM Elrodents and insects. <br /> EHD 16-2612127/2012 t <br /> CFO CLASS A CHECKLIST <br />