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Food Preparation Requirements (Includes packaging and handling): <br />Yes <br />No <br />11. <br />Hand washing is required immediately prior to handling foods and after engaging In <br />an a 'y a of : r.a-inataa :`a `ands s.o` as —I :.any : � :;,i:_. __aykng o, <br />u <br />u <br />sneezing, eating or smoking. <br />17 <br />Warts water hand snan and rlpan tnwela nrp availahlp fnr hand wachinn <br />V <br />NnI —IVVV :_a_OVlpe VON_.:1_.U'1O_ nr+___ <br />111,11 01011.111.11 eMM <br />U <br />U <br />14. <br />Potable water snail be used for hand washing, were washing and as an ingredient. <br />�J <br />U <br />15. <br />Is your water source a private well? <br />❑ <br />Rr <br />a. If YES, have you completed testing for bacteria and nitrate? <br />13 <br />❑ <br />11 <br />18. <br />Is vour water source a public water system or community services district? <br />NI <br />n <br />.:.!f YES ..ftt 1_ ��_ _<;6_ _._ r dl_ ;� City. of Escafon <br />During the preparation, packaging or handling of CFO products: <br />Yes <br />NO <br />17. <br />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. <br />Infarcts, small children, or pets are excluded from the kitchen. <br />❑ <br />19. <br />Smokinq is excluded./ <br />❑ <br />20 <br />Cny person with a rnntenious illness shell refrain from work irk thn CTO <br />l�l <br />I-1 <br />__.. <br />_.1 �_.�_......, _ _....._e'_ <br />Labelino Reauiremerlts: Yes No <br />21. A copy Cf ft label has boen aubmittcd to u 1'e Dcpa.t .cnt fcr ,.view and appivI. I. ❑ <br />22.1 have attached a sample iabei. L✓J ❑ <br />By sionino below you are oertifyino that you meet the reauirements of the California Homemade Food Act. AB 1616 <br />(Gattoj, as it pertains to a "Class A° Cottage Food Operation. Prior to making any changes, 1 acknowledge that I must <br />'•'• ,; Salt Jccqu,c Ca::^ , Ervlronmcntol Hcdth Dcparimcnt of acy lrtcndcd ahs❑gca ty Lhc cbo.c .......,,,cot. <br />nonage Food operator Checklist compietea ana sudmineo by: <br />-- <br />Britney Hussman 1/27/2022 <br />ure Print Name Date <br />EHD 162612177/2012 2 CFO CLASS A CHECKLIST <br />