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Environmental Health Department <br />NoYes <br />□X <br />□X <br />□X <br />X □a. <br />Pantry room <br />□X4. <br />NoYes <br />□X <br />Yes No <br />□X <br />□□ <br />X □ <br />□X <br />Yes NoSanitation Requirements: <br />□X <br />X □ <br />□X <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br />SELF CERTIFICATION CHECKLIST <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 />CFO ZIP: <br />95377 <br />SAN JOAQUIN <br />-----COUNTY <br />CFO Owner Name: <br />Spurthi Gottumukkala <br />CFO City: <br />Tracy <br />CFO Business Name: <br />Melting Moments by Spooh <br />CFO Address: <br />1773 Jade PI <br />Zoning Requirements: <br />5. 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 />use. <br />10. All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects. <br />Facility Requirements: <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br />2. All 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 />If YES, is the room used exclusively for storage? <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjcehd.com <br />The following requirements are outlined in the Cottage Food Operations (CFO) regulations and are provided as minimum standards of health <br />and safety for the preparation of approved cottage foods in the home. <br />Employee and Training Requirements: <br />6. 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.)