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SAN JOAQUIN COUNTY <br />F ENVIRONMENTAL HEALTH DEPARTMENT <br />< 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax. (209) 464-0138 web: www.siaov.orolehd <br />r <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 4 and safety for the preparation of approved cottage foods in the home. <br />CFO Business e: J<k rtl CFO Owner Name: <br />S ar ice°j� LLC S t \A-levw i&4 - <br />CFO Address: CFO City: CFO ZIP: <br />tie v aac R 53-7(p <br />Facility Requirements: <br />Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br />[ <br />❑ <br />2. All CFO food preparation will take'place in the private kitchen within that home. <br />1�1 <br />❑ <br />3. Additional storage used for the CFO will be within the home. <br />R( <br />El <br />a. If YES, is the room used exclusively for storage? <br />❑ <br />t� <br />b. Specify the room(s) that will be used for storage? KI G�1QYi <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />[vY <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 ❑ Y <br />processor course? <br />a. If YES, copies of certificates are attached. ❑ <br />b. If NO, complete course within 3 months f CFO registration. E( ❑ <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 />8. Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />Yes No <br />J <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 />rodents and insects. <br />EHD 16-26122712012 1 CFO CLASS A CHECKLIST <br />