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ww . 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.si.gov.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: tII- <br />A ail o t5 <br />CFO Owner Na e: <br />M tr10 <br />CFO Address: <br />5 OI4/1 C <br />CFO city: <br />CI- - <br />CFO ZIP: <br />Facility Requirements: <br />Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides A , ❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. ❑ <br />3. Additional storage used for the CFO will be within the home. �] ❑ <br />a. If YES, is the room used exclusively for storage? [> ❑ <br />b. Specify the room(s) that will be used for storage? d c 1 hck , <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. ❑ <br />Zoning Requirements: Yes No <br />5. 1 have complied with the applicable zoning requirements for the CFO. VL ❑ <br />Employee and Training Requirements: Yes No <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.J9 awl <br />7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or ❑ <br />household members are not included.) N' <br />Sanitation Requirements: <br />Yes No <br />8. Kitchen equipment and utensils used to produce CFO products are clean and jo ❑ <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 fT1 ❑ <br />rodents and insects. <br />EHD 16-261211712012 1 CFO CLASS A CHECKLIST <br />