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Labeling Requirements: <br /> Yes No <br />21 A copy of the label has been submitted to this Department for review and approval <br /> Xi 0 <br />22 I nave attached a sample label <br /> Xi <br />Food Preparation Requirements (Includes packaging and handling): Yes No <br />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 />12 Warm water, hand soap and clean towels are available for hand washing <br />13. All food Ingredients used in the CFO products are front 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? <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', 1 c q-ro tx, <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 kitc.hen. <br />18 Infants. small children, or pets are excluded Irorn the kitchen. <br />Smoking is excluded <br />Any person with a contagious illness shall refrain from work in the CFO <br />Yes No <br />X 0 <br />By signing below you are cenifying that Ku meet tne requirements 01 the California Homemade Food Act, AB 1615 <br />(Gado) as it pertains to a Class A' Cottage foida Operation Prior to maeing any changes. I acknowledge that I must <br />notify San Joaquin County Environmemal Health Depadmere of any intended changes to the above statement <br />Cottage Food Operator cttecxst competed and submitted by <br />C),e 11.1 Se et t; <br />Pont me <br />_1(4:2j 2a2 <br />Date <br />/7.-/I.A.4% <br />Sigriulurc