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r <br /> Yes No <br /> Food Preparation Requirements(includes packaging and handling): � <br /> to <br /> ing <br /> ds and after <br /> ng <br /> 11 Hand any activity ithat contaminates the hands sung is required immediately rch as aftler using the toilet,coughing or <br /> n ❑ <br /> sneezing,eating or smoking. ❑ <br /> 12. Warm water, hand soap and clean towels are available for hand washing. <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 /> I . 't ❑ <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.6ES,what is the name of the system or district? <br /> Yes No <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. I� <br /> 16. Infants,small children,or pets arelexcluded from the kitchen. 7P ❑ <br /> 19. Smoking is excluded. ❑ <br /> 20. Any person with a contagious Illness shall refrain from work in the CFO. ❑ <br /> Labeling Requirements: Yes No <br /> FA21. opy of the label has been submitted to this Department for review and approval. Elve 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. Pdor 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 andl submitted by: <br /> r 1 // " 4AZI <br /> Signature 'PnntName t <br /> Erm 16.20 r2araor2 2 CrO CLASS A CHECKUST <br />