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SANAOAQUIN COUNTY— Food Preparation Requirements (includes packaging and handling): Environmental Health Department Yes No 11. Hand washing is required immediately prior to handling foods and after engaging in any ❑ 16. activity that contaminates the hands such as after using the toilet, coughing or LEl TJ ❑ sneezing, eating or smoking. 12. Warm water, hand soap and clean towels are available for hand washing.El-- No 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or cz // 13. All food ingredients used in the CFO products are from an approved source. LP' ❑ Infants, small children, or pets are excluded from the kitchen. ❑ 14. Potable water shall be used for hand washing, ware washing and as an ingredient. 19 ❑ 15. Is your water source a private well? ❑ U 1 abe!i— Rnnuirmmnts: V-- K1- 21. A copy of the label has been submitted to this Department for review and approval. / ❑ 22. 1 have attached a sample label. ❑/ ❑ By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 (Gatto), as it pertains to a "Class A" Cottage Food Operation: Prior to making any changes, I acknowledge that I must notify San Joaquin County Environmental Health Department of any intended changes to the above statement. Cottage F od Operator Ch klist completed and submitted by: Sig at Print Name ��slc� / �T z9 z Dat 2 of EHD 16-26 6/29/17 CFO CLASS A CHECKLIST a. If YES, have you completed testing for bacteria and nitrate? ❑ 16. Is your water source a public water system or commun^ity� s`erv,(ces district? LEl TJ Ela. If YES, what is the name of the system or district. / 11 2C0l'-: During the preparation, packaging or handling of CFO products: Yes No 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or cz El ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. 18. Infants, small children, or pets are excluded from the kitchen. ❑ 19. Smoking is excluded. [] 20. Any person with a contagious illness shall refrain from work in the CFO. [� ❑ 1 abe!i— Rnnuirmmnts: V-- K1- 21. A copy of the label has been submitted to this Department for review and approval. / ❑ 22. 1 have attached a sample label. ❑/ ❑ By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 (Gatto), as it pertains to a "Class A" Cottage Food Operation: Prior to making any changes, I acknowledge that I must notify San Joaquin County Environmental Health Department of any intended changes to the above statement. Cottage F od Operator Ch klist completed and submitted by: Sig at Print Name ��slc� / �T z9 z Dat 2 of EHD 16-26 6/29/17 CFO CLASS A CHECKLIST