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SAN JOAQUIN COUNTY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.si4ov.orglehd <br /> ilppaY <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 /> Brt 's � rPaliOns Uv�11vI vv�wncn�l� <br /> CFO Add,, s: CFO City: CFO ZIP: <br /> 'n w"6rAe �Scvtl0Y1 °153ao <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides 9 ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. Q ❑ <br /> 3. Additional storage used for the CFO will be within the home. 19, ❑ <br /> a. If YES, is the room used exclusively for storage? E2 ❑ <br /> b. Specify the room(s)that will be used for storage? Qah <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. 0 ❑ <br /> Zoning Requirements: Yes No <br /> 5. 1 have complied with the applicable zoning requirements for the CFO. W ❑ <br /> Employee and Training Requirements: Yes No <br /> 6. Have all persons preparing or packaging CFO products completed the CDPH food El <br /> course? <br /> a. If YES, copies of certificates are attached. i ❑ <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 orElhousehold members are not included.) <br /> Sanitation Requirements: Yes No <br /> 8. Kitchen equipment and utensils used to produce CFO products are clean and El <br /> 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 Er ❑ <br /> use. <br /> 10. All food preparation and food and equipment storage areas shall be maintained free ofElrodents and insects. <br /> EHD 16-2612/27/2012 1 CFO CLASS A CHECKLIST <br />