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14 <br />CFO Business Name <br />CreationsLi ce_lebyQi-}'0,1 <br />CFO Address: <br />2_40 vJ Ho v <br />CFO Owner Name- <br />RUC-41/1cA COVG4-, <br />I <br />CFO City: <br />Nt3LIfrfhP1 <br />I CFO ZIP <br />Home_ c153.:11 <br />Yes No <br /> <br />1. The CFO is located in a private dwelling where the CFO operator currently resides 0:1 111 <br /> <br />2. All CFO food preparation will take place in the private kitchen within that home. LI <br /> <br />3. Additional storage used for the CFO will be within the home. Jz/ LI <br />If YES, is the room used exclusively for storage? dLI <br />Specify the room(s) that will be used for storage? ? CCe netS rl <br /> <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. 32/. LI <br />Facility Requirements: <br />8 Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />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 />All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects. <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209)464-0138 Web: <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 standards <br />of health and safety for the preparation of approved cottage foods in the home. <br />Zoning Requirements: Yes No <br />i 5. I have complied with the applicable zoning requirements for the CFO. El <br />Employee and Training Requirements: Yes No <br />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 />uzi <br />Sanitation Requirements: Yes No <br />El-ID 16-26 12/27/2012 <br /> 1 CFO CLASS A CHECKLIST