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Food Preparation Requirements (includes packaging and handling): <br />Yes No <br />11. Hand washing is required immediately prior to handling foods and after engaging in <br />Elany activity that contaminates the hands such as after using the toilet, coughing or <br />sneezing, eating or smoking. <br />12. Warm water, hand soap and clean towels are available for hand washing. (� ❑ <br />13. All food ingredients used in the CFO products are from an approved source. ❑ <br />14. Potable water shall be used for hand washing, ware washing and as an ingredient. ❑ <br />15. is your water source a private well? ❑ 19 <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? S ,� (p} J�"l� D✓l <br />During the preparation, packaging or handling of CFO products: Yes No <br />17. Domestic activities such as family meal preparation, dishwashing, clothes washing or �❑ <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <br />18. Infants, small children, or pets are excluded from the kitchen. ❑ <br />19. Smoking is excluded. �❑ <br />20. Any person with a contagious illness shall refrain from work in the CFO. ❑ <br />Labeling Requirements: <br />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 />1 have attached a sample label. <br />V <br />❑ <br />By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AS 1616 <br />(Gatto), as it pertains to a "Class A" Cottage Food Operation. Pdor 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 />I submitted by: <br />V t ►feast C -Z 1 -( / - 22 <br />Print Name Date <br />EHD 16-26 12/27/2012 2 CFO CLASS A CHECKLIST <br />