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Facility Requirements:Yes No □The CFO is located in a private dwelling where the CFO operator currently resides1. □2.All CFO food preparation will take place in the private kitchen within that home. □3.Additional storage used for the CFO will be within the home. □If YES, is the room used exclusively for storage?a. b. Specify the room(s) that will be used for storage? □4. Zoning Requirements:No □5. I have complied with the applicable zoning requirements for the CFO. Employee and Training Requirements:NoYes 6.$□ □If YES, copies of certificates are attached.a. □If NO, complete course within 3 months of CFO registration.b. 7.□□ Yes NoSanitation Requirements: 8.$□ 9.0 □ □ CFO CLASS A CHECKLIST1EHD 16-26 12/27/2012 The CFO has no more than 1 full-time equivalent employee? (Immediate family or household members are not included.) All food contact surfaces, equipment, and utensils used for the preparation, packaging, or handling of any CFO products shall be washed, rinsed, and sanitized before each use. Have all persons preparing or packaging CFO products completed the CDPH food processor course? Kitchen equipment and utensils used to produce CFO products are clean and maintained in a good state of repair. COTTAGE FOOD OPERATIONS (CFOs-CLASS A) SELF CERTIFICATION CHECKLIST $ □ San Joaquin County Environmental Health Department 1868 East Hazelton Avenue, Stockton, CA 95205-6232 Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd CFO ZIP: fa)0h0 Sleeping quarters are excluded from areas used for CFO food preparation or storage. Yes ¥ The following requirements are outlined in the Cottage Food Operations (CFO) regulations and are provided as minimum standards of health and safety for the preparation of approved cottage foods in the home. 10. All food preparation and food and equipment storage areas shall be maintained free of rodents and insects. CFO Owner Name: C/W Teuz? CFO City. CFO Business Name: twigs CAm CFO Address: ^33g> GaNTROU/U