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� Old I�f2gr�ftilnr� i SAN JOAQUIN COUNTY a. x` ENVIRONMENTAL HEALTH DEPARTMENT ::Mk 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 4640138 Web: e,Fae.. COTTAGE FOOD OPERATIONS (CFOs -CLASS A) SELF CERTIFICATION CHECKLIST The following requirements are outlined in the Cottage Food Operations (CFO) regulations and are provided as minimum standards of health and safety for the preparation of approved cottage foods in the home. C eusines ame: CF Omer Name: �a yea4" De 4� 7L t C CFO Address: CFO Cfty: CFO ZIP: b,�-? 3 C lit haver) t4l I5j`v c q 6 Facility Requirements: Yes No 1. The CFO is located in a private dwelling where the CFO operator currently resides Rr ❑ 2. All CFO food preparation will take place in the private kitchen within that home.]' ❑ 3. Additional storage used for the CFO will be within the home. ur ❑ a. If YES, is the room used exclusively for storage? ❑ ❑ b. Specify the room(s) that will be used for storage? �/ El 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. ❑ Zoning Requirements: Yes No 5. 1 have complied with the applicable zoning requirements for the CFO. CJ ❑ Employee and Training Requirements: Yes No 6. Have all persons preparing or packaging CFO products completed the CDPH food ❑ processor course? a. If YES, copies of certificates are attached. ❑ b. If NO, complete course within 3 months of CFO registration. ❑ ❑ 7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or �/ El members are not included.) Sanitation Requirements: Yes No 8. Kitchen equipment and utensils used to produce CFO products are clean and El in a good state of repair. 9. All food contact surfaces, equipment, and utensils used for the preparation, packaging, or handling of any CFO products shall be washed, rinsed, and sanitized before each C�r ❑ use. 10. All food preparation and food and equipment storage areas shall be maintained free of El and insects.