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11 Hand washing is required immediately prior to handling foods and after engaging in <br />any activity that contaminates the hands such as after using the toilet, coughing or <br />sneezing, eating or smoking <br />0 <br />12 Warm water, hand soap and clean towels are available for hand washing NLJ <br />13 All food ingredients used in the CFO products are from an approved source. IA 0 <br />14 Potable water shall be used for hand washing, ware washing and as an ingredient. N 0 <br />15 Is your water source a private well? 21 <br />a If YES, have you completed testing for bacteria and nitrate? n 00 <br />16 Is your water source a public water system or community services district? (2 <br />a. If YES, what is the name of the system or district? Lod/ u:// bez <br /> <br />During the preparation, packaging or handling of CFO products: <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 />Yes No <br />Food Preparation Requirements (includes packaging and handling): Yes No <br />Labeling Requirements: Yes No <br />21. A copy of the label has been submitted to this Department for review and approval. <br />22 I have attached a sample label. <br />By signing below you are certifying that you meet the requirements of the California 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 />MdiSscrq grbt04 <br /> <br />Print Name Date Signature <br />DID 16-26 12,27'2012 2 CFO CLASS A CHECKLIST