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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />l 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: wwwsigov.org/ehd <br />rFiS'w <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 Nam: CFO Ter Name: <br />kl� S LLG'c UI, n] <br />CFO Address: iiq CFO City: CFO ZIP: <br />Facility Requirements: <br />Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br />0 <br />❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. <br />El/ <br />3. Additional storage used for the CFO will be within the home. <br />_/ <br />tL <br />❑ <br />a. If YES, is the room used exclusively for storage? <br />[ <br />❑ <br />b. Specify the rooms) that will be used for storage? kilt n <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />❑ <br />Zoning Requirements: Yes No <br />5. 1 have complied with the applicable zoning requirements for the CFO. ❑ <br />Employee and Training Requirements: Yes No <br />6. Have all persons preparing or packaging CFO products completed the CDPH food ❑ <br />processor course? Lr� <br />a. If YES, copies of certificates are attached. ❑ <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 or ( El, <br />household members are not included.) '�f� <br />Sanitation Requirements: <br />Yes No <br />8. Kitchen equipment and utensils used to produce CFO products are clean and d Elmaintained 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 l� ❑ <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 1 CFO CLASS A CHECKLIST <br />