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Food Preparation Requirements (includes packaging and handling):Yes No <br />□ <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?Mountain House in San Joaquin county <br />Yes NoDuring the preparation, packaging or handling of CFO products: <br />□ <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:Yes No <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 />Cottage Food Operator Checklist completed and submitted by: <br />Theresa Flores 12-19-202-1 <br />Signature Print Name Date <br />2 CFO CLASS A CHECKLISTEHD 16-26 12/27/2012 <br />By signing 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 />□ <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />0 <br />□ <br />0 <br />0 <br />0 <br />17. Domestic activities such as family meal preparation, dishwashing, clothes washing or <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <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.