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<br /> <br />No <br /> Yes <br />4 <br />Yes No <br />SI <br />Yes NoSanitation Requirements: <br />$ □ <br /> <br />EH016-26 12/27/2Q12 <br />CFO CLASS A CHECKLIST <br />1 <br />Na o’ <br /> <br />u <br />& <br />SJ <br />CFO ZIP <br />$ <br />Yes <br />I CFO Business Name. <br />LL&YM *5 Oc/'ft.hws___ <br />I CFO Address <br />iKfroV*Ac*x LWfc <br />Zoning Requirements: <br />I have complied with the applicable zoning requirements for the CFO. <br />8. Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />9. 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 />Uoc. <br />Facility Requirements: <br />1 The CFO is located in a private dwelling where the CFO operator currently resides <br />. 2 AU CFO food preparation will take place in the private kitchen within that home. <br />, 3 Additional storage used for the CFO will be within the home. <br />a. If YES. is the room used exclusively for storage? <br />b. Specify the room(s) that will be used for storage? <br />Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />1°‘ rodents anXsectsequiPrnent storage areas shall be maintained free of <br />Employee and Training Requirements: <br />Have all persons preparing or packaging CFO products completed the CDPH food <br />processor course? <br />a. If YES. copies of certificates are attached. <br />b 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 />Environmental Health D^partme^^^ <br />t , 1868 East Hazelton Avenue. Slow un. - <br />Telephone: (209) 468-3420 Fax: (209) 464-01 JO <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br />SELF CERTIFICATION CHECKLIST <br />The following requirements are outlined in the Cottage Food Opemtions (CFO) regulations and are provided as n i im <br />of health and safety for the preparation of approved cottage foods m the home <br />”TCFO Owner Name <br />LMAiW <br />L [ CFO City <br />2-O0\ __