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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c� iFoa�/ Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si_qov.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: /� /� ' CFO Owne[�Name, <br /> X411- a- G�yt hf�CYlBE1 �S� j'G(iYIE'lli' 7 LX <br /> CFO Address: CFO City: CFO ZIP: <br /> pq� ,Vej,lk�h4re <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides Ef ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. 2" ❑ <br /> 3. Additional storage used for the CFO will be within the home. Er ❑ <br /> a. If YES, is the room used exclusively for storage? Er ❑ <br /> b. Specify the room(s) that will be used for storage? 6,4ra r� <br /> 4. Sleeping quarters are excluded from areas used for CFO f re ara ' r storag . <br /> Zoning Requirements: Yes No <br /> 5. 1 have complied with the applicable zoning requirements for the CFO. 0, ❑ <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 orElhousehold members are not included.) <br /> Sanitation Requirements: Yes No <br /> 8. Kitchen equipment and utensils used to produce CFO products are clean and ©/ ❑ <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 2'� ❑ <br /> use. <br /> 10. All food preparation and food and equipment storage areas shall be maintained free of ®/ ❑ <br /> rodents and insects. <br /> EHD 16-261212712012 7 CFO CLASS A CHECKLIST <br /> �� 2 <br />