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ae�uln• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Yy. 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 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 />Kai's Kitchen 808 Kainoa Garcia <br />CFO Address: CFO City: CFO ZIP: <br />1263 South Palermo Lane Mountain House 95391 <br />Facility Requirements: <br />Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br />❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. <br />❑x <br />❑ <br />3. Additional storage used for the CFO will be within the home. <br />❑x <br />❑ <br />a. If YES, is the room used exclusively for storage? <br />❑ <br />b. Specify the room(s) that will be used for storage? Kitchen <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />© <br />❑ <br />Zoning Requirements: Yes No <br />5. 1 have complied with the applicable zoning requirements for the CFO. ® ❑ <br />Employee and Training Requirements: <br />Yes No <br />6. Have all persons preparing or packaging CFO products completed the CDPH food Elprocessor course? <br />a. If YES, copies of certificates are attached. ❑ <br />b. If NO, complete course within 3 months of CFO registration. X❑ ❑ <br />7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or 9 El <br />members are not included.) <br />Sanitation Requirements: <br />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 El <br />and insects. <br />EHD 16-26 12/27/2012 <br />t <br />CFO CLASS A CHECKLIST <br />