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Facility Requirements:Yes No <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?a. <br />b. Specify the room(s) that will be used for storage?Kitchen Pantry <br />□Sleeping quarters are excluded from areas used for CFO food preparation or storage.4. <br />Zoning Requirements:Yes No <br />□5.I have complied with the applicable zoning requirements for the CFO. <br />Employee and Training Requirements:Yes No <br />6.□ <br />□If YES, copies of certificates are attached.a. <br />□□b.If NO, complete course within 3 months of CFO registration. <br />7.□ <br />Sanitation Requirements:Yes No <br />□ <br />9.□ <br />□ <br />EHD 16-26 12/27/2012 1 CFO CLASS A CHECKLIST <br />8. Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />10. All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects. <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 />The CFO has no more than 1 full-time equivalent employee? (Immediate family or <br />household members are not included.) <br />Have all persons preparing or packaging CFO products completed the CDPH food <br />processor course? <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br />SELF CERTIFICATION CHECKLIST <br />CFO ZIP: <br />95207 <br />San Joaquin County <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd <br />□ <br />□ <br />□ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />CFO Owner Name: <br />Kim Agelina Roman <br />CFO City: <br />Stockton <br />CFO Business Name: <br />Roman’s Recipes <br />CFO Address: <br />2218 Polk Way <br />The following requirements are outlined in the Cottage Food Operations (CFO) regulations and are provided as minimum standards <br />of health and safety for the preparation of approved cottage foods in the home. <br />r Iwlearfrn