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Food Preparation Requirements (includes packaging and handling): Yes No <br />11. Hand washing is required immediately prior to handling foods enol :oloi engaging in <br />any activity that contaminates the hands such as after using tho 1-1 oughing or ❑ <br />sneezing, eating orsmoking. <br />12. Wane water, hand soap and clean towels are available for hand washing. C; ❑ <br />13. All food ingredients used in the CFO products are from an approved source. <br />14. Potable water shall be used for hand washing, ware washing and as an ingredient. <br />15. Is your water source a private well? <br />a. If YES, have you completed testing for bacteria and nitrate? <br />16. Is your water source a public water system or community services district? <br />a. If YES, what is the name of the system or district? <br />During The preparation, packaging or handling of CFO products: `" <br />17. Domestic activities such as family meal preparation, dishwashing, clothes washing or <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <br />18. Infants, small children, or pets are excluded from the kitchen. <br />19. Smoking is excluded. <br />20. Any person with a contagious illness shall refrain from work in the CFO. <br />Yes No <br />Labeling Requirements: Yes No <br />21. A copy of the label has been submitted to this Department for review and approval. ❑ <br />22. 1 have attached a sample label. ❑ <br />By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 <br />(Gatto), as it pertains to a'Class A' Cottage Food Operation. Prior to making any changes, I acknowledge that I must <br />notify San Joaquin County Environmental Health Department of any intended changes to the above statement. <br />Cottage Food Operator Checklist completed and submitted by: <br />Signature �hT a e J Dated <br />EHD 16-26 1X272012 2 CFO CLASS A CHECKLIST <br />