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a*'T"'"• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />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 />mt aab -beanna, L_ Farmer <br />CFO Address: CFO City: CFO ZIP: <br />CI -74-L W 15M-k-bV01 Rd- LI nden g523(Q <br />Facility Requirements: <br />Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides ET� ❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. R�" ❑ <br />3. Additional storage used for the CFO will be within the home. EK ❑ <br />a. If YES, is the room used exclusively for storage? ❑ <br />b. Specify the room(s) that will be used for storage? �Y" <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. [� ❑ <br />Zoning Requirements: <br />5. 1 have complied with the applicable zoning requirements for the CFO. <br />Employee and Training Requirements: <br />6. Have all persons preparing or packaging CFO products completed the CDPH food <br />processor course? <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 <br />household members are not included.) <br />Sanitation Requirements: <br />Yes No <br />Lei <br />Yes No <br />LE)_✓' <br />L7 ❑ <br />❑ ❑ <br />V ❑ <br />Yes No <br />8. Kitchen equipment and utensils used to produce CFO products are clean and ©/ 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 ❑ <br />use. <br />10. All food preparation and food and equipment storage areas shall be maintained free of <br />Elrodents and insects. <br />EHD 16-26 12/27/2012 1 CFO CLASS A CHECKLIST <br />