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a�aHin. SAN JOAQUIN COUNTY <br /> �> A4 <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c.. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.orolehd <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br /> SELF CERTIFICATION CHECKLIST <br /> The folbwing requirements are outlined in the Coffmga Food Operations(CFO)regulations and are provided as minimum standards <br /> of healfti and safety for the preparation of approved collage foods in the frame. <br /> CFO Business Name: CFO Owner Name: <br /> z tl. yrs LI se V>bde2 <br /> CFO Address' CFO City: CFO ZIP: <br /> qIQ 1,r. -v — I g S3-7,6 <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides Ir ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. ❑ Ir <br /> 3. Additional storage used for the CFO will be within the home. 0 ❑ <br /> a. If YES, is the room used exclusively for storage? 0 ❑ <br /> b. Specify the room(s)that will be used for storage? 61?(24' <br /> 4. Sleeping quarters are excluded from areas used for CFO food pr�on or storage. (8 ❑ <br /> Zoning Requirements: Yes No <br /> 5. [ 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 <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 pf El <br /> members are not included.) Jam+ <br /> Sanitation Requirements: Yes No <br /> 8. IGtchen equipment and utensils used to produce CFO products are clean and El <br /> 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 J� ❑ <br /> use. <br /> 10. All food preparation and food and equipment storage areas shall be maintained free of ❑ <br /> rodents and insects. <br /> E KD 162612272012 1 CFO CLASS A CMECKOST <br />