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fe2 <br />RI 0 <br />1 The CFO is located in a private dwelling where the CFO operator currently resides <br />2. All CFO food preparation will take place In the private kitchen within that home, <br />3 Additional storage used for the CFO will be within the home. <br />If YES, is the room used exclusively for storage? <br />Specify the room(s) that will be used for storage? 11. <br />4 Sleeping quarters are excluded from areas used for CFO food preparation or st <br />Cic ,Business Name: <br />9a.,k <br />CFO Address: <br />c2,19 lie recrak <br />Facility Requirements: <br />cro CII <br />STO kT0A/ <br />Cio 'ZIP <br />2( <br />Yea No <br />1 <br /> cro Owner Name <br />Denise Al i <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Tolophono: (209) 468-3420 Fox: (209) 464-0138 Wob: myyy. sjim,orgtptist <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 standarde <br />of health and safety for the preparation of approved cottage foods In the home, <br />Zoning Requirements: <br />Yes No <br />5. I have complied with the applicable zoning requirements for the CFO, <br /> <br />Employee and Training Requirements: <br /> - <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 />The CFO has no more than 1 full-time equivalent employee? (Immediate family or <br />household members are not included) <br /> <br />Sanitation Requirements: <br />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 <br />use. <br />10 All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects <br />Yes No <br />[HO 16-A 12/2/2012 <br />H <br />E LI <br />D1003112°1 <br />A r.1tr,i(Lei,7