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NoFood Preparation Requirements (includes packaging and handling):Yes S □ □ 13. All food ingredients used in the CFO products are from an approved source 14, Potable water shall be usod for hand washing, ware washing and as an ingredient. 15. Is your water source a private welt? a It YES. have you completed testing for bacteria and nitrate? 16. Is your water source a public waler system or community services district? a. if YES, what is the name of the system or district? NoYesDiuwg the pnspamhofl, packaging or harKfiing of CFO products: 3 □ Yes NoLabeling Requirements: 21. A copy of the label has been submitted to this Department for review and approval 22. I have atladied a sample label JYW Name CFO CLASS A CHECKL’ST2£K) laarzaoia 19. Smoking is excluded. 2D. Any person with a contagious Illness shall refrain from work in the CFO. 11 Hand washing Is required Immediately prior to handling foods and aftei engaging in any activity that contaminates the hands such as after using the loifei, coughing or sneezing, eating or smoking 12 Warm water, hand soap and clean towels are available for hand washing a 3 H 3 a B n □ □ □ □ □ 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or ironing, kitchen cleaning or guest entertainment are excluded from the kitchen 18 Infants, small children, or pets are excluded from the kitchen S e □ □ □ a Cottage Food Operator Checkfet compieteu and submitted by Signature Fiy signaig below you are ceitfymg that you meet inc requirements o’* the Calltom® Hcmemado Food Act AB 151B ’■Gatto), as it pertains to a 'Class A' Collage Food Operation Prior to making any changes, I acknowledge that I must notify San Joaq^r- County Environmaotal HoalUi Deportment at any intended changes to the abow statement