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Food Preparation Requirements(includes packaging and handling): Yes No <br /> 11. Hand washing is required immediately prior to handling foods and after engaging in <br /> any adivity that contaminates the hands such as after using the toilet, coughing or �'] ❑ <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? ❑ �—j/ <br /> a If YES, have you completed testing for bacteria and nitrate? EJ ❑ <br /> 16 Is your water source a public water system or community services district? h[J ❑ <br /> a.If YES, what is the name of the system or district? ��Q� q� <br /> During the preparation, packaging or handling of CFO products Yes No <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. El19. Smoking is excluded. M ❑ <br /> 20. Any person with a contagious illness shall refrain from work in the CFO. ❑ <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 Ermronmemal Health Department of arty intended changes to the above statement, <br /> Cottage Food Operator Checklist completed and submitted by <br /> Li �,�� � f � 11111d r <br /> Signedae Print N me Dale <br /> Ertp is 26 12Rr/2012 01M CLASS A MCA1151 <br />