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Food Preparation Requirements (includes packaging and handling): Yes No <br />11. <br />Hand washing is required immediately prior to handling foods and after engaging in <br />Elironing, <br />kitchen cleaning or guest entertainment are excluded from the kitchen. <br />22. <br />any activity that contaminates the hands such as after using the toilet, coughing or <br />©' <br />❑ <br />❑ <br />sneezing, eating or smoking. <br />❑ <br />12. <br />Warm water, hand soap and clean towels are available for hand washing. <br />+� <br />❑ <br />13. <br />All food ingredients used in the CFO products are from an approved source. <br />❑ <br />14. <br />Potable water shall be used for hand washing, ware washing and as an ingredient. <br />4Z <br />❑ <br />15. <br />Is your water source a private well? <br />❑ <br />E3" <br />a. If YES, have you completed testing for bacteria and nitrate? ❑ ❑ <br />16. Is your water source a public water system or community services district? ❑ <br />a. If YES, what is the name of the system or district?iC tt S'b G ��""' <br />During the preparation, packaging or handling of CFO products: 1 Yes No <br />17. Domestic activities such as family meal preparation, dishwashing, clothes washing or <br />A copy of the label has been submitted to this Department for review and approval. <br />Elironing, <br />kitchen cleaning or guest entertainment are excluded from the kitchen. <br />22. <br />i have attached a sample label, <br />18. Infants, small children, or pets are excluded from the kitchen. <br />,—✓ <br />�l <br />❑ <br />19. Smoking is excluded. <br />❑ <br />20. Any person with a contagious illness shall refrain from work in the CFO. <br />0"' <br />❑ <br />Labeling Requirements: Yes No <br />21. <br />A copy of the label has been submitted to this Department for review and approval. <br />❑ <br />❑ <br />22. <br />i have attached a sample label, <br />❑ <br />❑ <br />By signing below you are certifying that you meet the requirements of the Cafrfornia Homemade Food Act, AB 1616 <br />(Gatto), as it pertains to a "Class A" Cottage Food Operation. Prior to making any changes, I acknowledge that I must <br />notify San Joaquin County Environmental Health Department of any intended changes to the above statement. <br />Cottage Food Operator Checklist completed and submitted by: <br />Signature Print Name Date <br />EHO 16-2612/27/2012 2 CFO CLASS A CHECKLIST <br />LL—) <br />