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CFO Business Name: <br />5RI \i44RA 4-Jf rebtoc <br />CFO Address: <br />2510 RID C,IR AND& DK <br />CFO Owner Name: <br />5 ft -NTO.51)11D6D#M7) 60i4079 MALI <br />CFO City: CFO ZIP: <br />-1 TRric))) 6A <br /> <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br /> <br />2. All CFO food preparation will take place in the privat kitchen within that home. <br /> <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? <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. 4zi <br />visor, s • Vs/ •••• •—• •••• • • • ••••• •••• • II • • <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.orq/ehd <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 />Facility Requirements: Yes No <br />Zoning Requirements: <br /> Yes No <br />5. I have complied with the applicable zoning requirements for the CFO. 421 <br />Employee and Training Requirements: <br /> Yes <br />6. Have all persons preparing or packaging CFO products completed the CDPH food <br />processor course? <br />If YES, copies of certificates are attached. <br />If NO, complete course within 3 months of CFO registration. <br />7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or <br />household members are not included.) <br />Sanitation Requirements: <br /> Yes No <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 />10. All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects. <br />FH1") 1A-9A 19/97/9C119 1 AS A r.HFC:10 ST