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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1668 East HateItan Avenue, $locklidn. CA 952054732 <br />Tehgthone! (209) 4664420 Fel: 12M:1464-0138 w.yoyeatzbesggehj <br />1 CFO VP <br />O-5007 <br />I <br />CFO {Mimi Marne <br />AIWA Greby <br />CIO &swami Narns <br />Wyk.; We Hwy <br />CFO Mama <br />2341 S:araeld di <br />S I Mors complied Mb Ito opplicatrlo zoom nogiltomente tot the CFO. <br />2 A0 CFO load ocepareton *al take glace in the prole tr lichen yrAhri Chat Satre <br />3 Addrtranai slceage used 'or the CFO wit be the trorne <br />a ti YES, n the racen used ezdaJsrealy for stcear7 <br />b the room's' tria!wa be usad ice sloracre'l <br /> ouschrn <br />4 Sleetiev ttgarle4 are erauded lroce areas used tor CFO food preoarators rsivoae LI <br />Zoning Riquhrernatts: Yes No <br />D <br />tg ,v 1994 idv pvot.KA tin4tç Prig 9949011Y4119(450, 409#1091 bç im#11141"i911 1199. 9t <br />1'040044ml Asada <br />IR% 't 71 iF4FO4ti CFO CUSS A CHICF141 <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br />SELF CERTIFICATION CHECKLIST <br />rh• tz47d.,0-1rpwrwentrt1 catcyr.1 704117,4uyr m1e OrWOn1 11.7 .119140414 I aeld wiVOI41w1 rnilendrt Ilts'41011 <br />Insiedi and !dirty iv ea TherdraN-.n int ainlvmeod cnearis /beds 41 LP& Prrnii <br />natty Riqudierneets: <br />1 The CFO ts towed in petvaln ctivelling .fthera the CFO opefatcf amenity resides <br />Employes sod Ttaining Requirements: Yee No <br />5R1040011ROqU10911014011: <br />_ <br />R Fragchela, tri,kprnant 0(0 &Mesa% tri,nd lo prrAltroa CFO product, ana clean arse <br />hiant4 hod In a gzol stale ?toe <br />9 AP IDA contact s•xlaces, e•quitrient, ard ttersis used tor the pre,paralocn, pac;ng, <br />or Undo; a! any CFO products shall be washed. (wised, and sant:zed betbrn end" <br />UStr <br />6 flay() At tioRtsbet oreporalgo atitOgre) CFO rioclutts elYrOelegl the CDPH 'ood <br />procoswr course" <br />ft 0 YES. Wises Ctilltica191.3r0 a0.3040 <br />t1 NO corirteln coon.° le'rei 3 nOri101 Of CFO regnicalon <br />1. The CFO has no MOM that 1 fuLtirre edurrela(it efrOtOyee itromedlate farrAV (-)t <br />household Inentees ere not ',chided.) <br />m a <br />CFI 0 <br />00 <br />3 0 <br />4