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NoYes <br />NoYes <br />Signature <br />4 <br />Date <br />Yes <br />~cr <br />& <br />(X <br />_____ <br />No <br />1 <br />Lw'ti <br />Print Name <br />,liable for hand washing. <br />. from an approved source. <br />-ashing and as an ingredient. <br /> . 3 <br />St ■ <br />Labeling Requirements:--------------------- --------------------------- - --------------- ------------------ <br />[21. A copy of^eT^been submitted to this Department tor review and approvat. <br />/ 22. I have attached a sample label. <br />( vnu meet the requirements of the California Homemade Food ^’.J^t^must <br />By signing below you are certifying that y operation. Prior to making any changes, I acknowledge t <br />(Gatto), as it pertains to a “Class A Cottag Department of any intended changes to the above statement. <br />notify San Joaquin County Env.ronmental Health u <br />Cottage Food Operator Checklist completed and submitted by. <br />; ■ Iff ' <br />and handling)*_ <br />Food Preparation Requirements (includes packagmgan ^'"^gaging in <br />IS required .mmediately prior to handlin9 ^^t^toilet. coughing or <br />any activity that contaminates the hands such as after us y <br />sneezing, eating or smoking <br />12 Warm water, hand soap and clean towels are avai <br />13 All food ingredients used in the CFO products are <br />12$ potable water shall be used for hand washing warewi <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? (\\\^ (A \oc\x <br />During the preparation, packaging or handling of CFO products: <br />17 Domestic activities such as family meal preparation. dis^s.h;2nV^^^ <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 comagrous illness shall refran from work InlheCFO---------------