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NoYes <br />& <br />Yes <br />or SI <br />EHD >28 1207/2012 ?CFO CLASS A CHECKLIST <br />1; <br />Yes <br />IT <br />Ki <br />0 <br />0 <br />0 <br /> <br /> <br />B <br />No <br />o’ <br />0 <br />0 <br />M <br />Aziza <br />Print Name'' Signature <br />61(0125 <br />Date <br />Labeling Requirements:____ ____________________________ <br />21. A copy of the label has been submitted to this Department for review and approval. <br />22. I have attached a sample label. <br />By signing below you are certifying that you meet the requirements of the California Homemade Food Act. AB 1616 <br />(Gatto) as it pertains to a ‘Class A" Cottage Food Operation. Prior to making any changes. I acknowledge that I must <br />notify San Joaquin County Environmental Health Department of any Intended changes to the above statement. <br />Cottage Food Operator Checklist completed and submitted by: <br />Food prwnaration Requirements (Includes packaging and handling):---------------------- <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 from 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? c <br />During the preparation, packaging or handling of CFO products: <br />17 Domestic activities such as family meal preparation, dishwashing, clothes washing <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <br />18. Infants, small children, or pets are excluded from the kitchen. <br />19. Smoking is excluded. <br />20. Any person with a contagious illness shall refrain from work in the CFO. <br /> <br /> <br /> <br />ol Lo<^ CVvUtG <br />No