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Hand washing is required immediately prior to handling foods and after engaging in any <br />activity that contaminates the hands such as after using the toilet, coughing or <br />sneezing, eating or smoking. <br />Warm water, hand soap and clean towels are available for hand washing. <br />All food ingredients used in the CFO products are from an approved source. <br />Potable water shall be used for hand washing, ware washing and as an ingredient. <br />Is your water source a private well? <br />a. If YES, have you completed testing for bacteria and nitrate? <br />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? rA001JIA <br />During the preparation, packaging or handling of CFO products: <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 />Infants, small children, or pets are excluded from the kitchen. <br />Smoking is excluded. <br />Any person with a contagious illness shall refrain from work in the CFO. <br />Yes No <br />Signature <br />F.mironitiental Health Department <br />Food Preparation Requirements (includes packaging and handling): Yes No <br />Labeling Requirements: Yes No <br />A copy of the label has been submitted to this Department for review and approval. <br />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 (Gatto), as it pertains <br />to a "Class A" Cottage Food Operation. Prior to making any changes, I acknowledge that I must notify San Joaquin County Environmental <br />Health Department of any intended changes to the above statement. <br />Cottage Food Operator Checklist completed and submitted by: <br />A 4 12,4-1iR Aril 4\11 ti -IAI• IDZAN 10 <br />Print Name Date <br />END 16-26 6/29/17 CFO CLASS A CHECKLIST