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s, SAN JOAQUIN COUNTY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> \ ?jl <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> i Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> iraa� <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 Na I <br /> A54 1053om Ic¢ dial 00[2 <br /> CFO Address: CFO Ity: CFO ZIP: <br /> '(OZ Quail Run C;rcu -rrA LA. x5377 <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides ® ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. JK ❑ <br /> 3. Additional storage used for the CFO will be within the home. ® ❑ <br /> a. If YES, is the roam used exclusively for storage? 9 ❑ <br /> b. Specify the room(s)that will be used for storage? ar a <br /> 4. Sleeping quarters are excluded from areas used for CFO fo or storage. ® ❑ 1v_�l`� �p <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 ® El <br /> 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 ® El <br /> members are not included.) <br /> Sanitation Requirements: Yes No <br /> 8. 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 E]rodents and insects. <br /> EHD 16.2612/27/2012 1 CFO CLASS A CHECKLIST <br />