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Yes No <br /> Food Preparation Requirements (Includes Perluging end handling) <br /> t 1 Hand washing is requited immediately prior to handling foods And Aftet eft hg r I [� <br /> any activity ttial conlamrnatos tho hands suCh as after using the toilet. C" <br /> r'9 Or <br /> sneezing, eating ur smoking ,�.,/ ❑ <br /> 12 Warm water hand soap and clean towels are available for hand washing �y ❑ <br /> 13 All food ingredients used in the CFO products are from an approved source 1 <br /> 14 Potable water shall be used for hand washing, ware washing and as an rngredl,n1 C ❑ <br /> 19 Is your water source a pnvate Weil? <br /> will YES. have you completed tasting for bacteria and nitrate? <br /> ❑ ❑ <br /> I��1✓ <br /> 16 is your water sourre a public water system or community services district? ❑ `� i <br /> a if YES. what is the name of the system or drstnct? <br /> Yes No <br /> Dunng the preparation, packaging or handling of CFO productk � <br /> 17 Domestic activities such as family meal preparation,deshwas,rreng.clothes washing or ❑ <br /> waning.kitchen Leaning or guest entertainment are excluded from the ki"en <br /> 1s li nts,. small children,or pets aria exctuded from the i acherr t�5 ❑ <br /> 19 Smokinq is excluded ❑ <br /> 20. Any person with a contagious iltness shall retrain from work to the CFO ❑ <br /> Libeling Requlromenta: Yes No <br /> 21 A copy of the label has been submitted to this Department for review and approval � ❑ <br /> 22 1 have attached a sample label a ❑ <br /> By SPWWV Win, Y*V are 08"Aytiv trial yam, meet the requvementx of the Calitomea a Imft err tomcod Act, AB 1616 <br /> (Gala).anti it Wtarr►s to a'Ctam A- Cottage pond Olmntsrn tenor to making any cr4wig a. I ec6w%, eteddg* that I must <br /> notrty San Joequrn County Ewmnenental F,iealth Departmwnr E.t any intended changq m fee aatSae siatement <br /> t`.DRBpe f operatic Cf completed and subnvtted by <br /> Pnnf Name Date <br /> 2 drfl t:t.JCQ17S J1 i:.'3�'L�"5F <br />