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Environmental Health Departme <br />Li' <br />Facility Requirements:Yes No <br />1.□x <br />ox <br />ox <br />a. If YES. is the room used exclusively for storage?u ox <br />kitchen, diningb. Specify the room(s) that will be used for storage? <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage ox <br />Yes No <br />□x <br />Yes No <br />□X <br />ox <br />NoYes <br />□x8 <br />S.Q□X <br />□X <br />Stockton. California 95205 | T 209 468-3420 |1868 E. HareMon Avenue | <br />CfOZIP: <br />95240 <br />CFO Owner Name' <br />Hollie Lynch <br />CFO City <br />Lodi <br />CFO Business Name <br />Hearth & Home Sourdough Grannola Co. <br />CFO Address <br />402 1st Street <br />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 />F 209 4644)138 | wwwsjceM com <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br />SELF CERTIFICATION CHECKLIST <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.)_________________________ <br />Sanitation Requirements^__________________________ <br />Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />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 />Zoning Requirements: <br />5 I have complied with the applicable zoning requirements for the CFO. <br />SANJOAOUIN <br />-COUNTY----- <br />Greatness grows here.