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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.spov.orq/ehd <br /> <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 BusinessAaine: <br />an+ RA ciTh Li vi VICi <br />i SOD nirci uak <br />CFO Owner Name: <br />D—Ce <br />CFO City: <br />LOCk f <br />CFO Address: CFO ZIP: <br />W —Z tie <br />Facility Requirements: Yes No <br />1 The CFO is located in a private dwelling where the CFO operator currently resides RI 0 <br />2 All CFO food preparation will take place in the private kitchen within that home. g <br />3 Additional storage used for the CFO will be within the home. lg• <br />If YES, is the room used exclusively for storage? Ig 0 <br />Specify the room(s) that will be used for storage? 1°C(4-CLAVG riravm (66) <br />4 Sleeping quarters are excluded from areas used for CFO food preparation or storage. cki <br />Zoning Requirements: Yes No <br />5. I 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 />If YES, copies of certificates are attached. <br />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 <br />household members are not included.) <br />Sanitation Requirements: Requirements: Yes No <br />Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />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 />nth" <br />EHD 16-26 12/27/2012 1 CEO CLASS A CHECKLIST