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NoYes <br />□0 <br />No <br />or □0 <br />0 <br />NoYes <br />I <br />7 CFO Cl A CMFCKI ISTFMO IB ?A I’C7001 f <br />□ <br />□ <br />□ <br />□ <br />□ <br />□ <br />□ <br />□ <br />□ <br />□ <br />□ <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 />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 />Date/Print Name <br />0 <br />0 <br />□ <br />□ <br />0 <br />Yes <br />By sigmna 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 ChecklisUompleted and submitted by <br />Food Preparation Requirements (includes packaging and handling): <br />11 Hand washing is required immediately prior to handling foods and after engaging in <br />any activity that contaminates the hands such as after using the toilet, coughing or <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? Cl -ky