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F5 <br />1 <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 />Zoning Requirements: <br />5. I have complied with the applicable zoning requirements for the CFO. <br />NoEmployee and Training Requirements:Yes <br />If YES, copies of certificates are attached.a. <br />If NO, complete course within 3 months of CFO registration.b. <br />Yes NoSanitation Requirements: <br />9.0 <br />i CFO CLASS A CHECKLISTEHD 16-26 12/27/2012 <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 />■z. <br />ro <br />0 <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 />3. Additional storage used for the CFO will be within the home. <br />a. If YES, is the room used exclusively for storage? tj-CS <br />b. Specify the room(s) that will be used for storage? '"RcCw/} <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />Yes No <br />Yes No <br />$ □ <br />jzf <br />Ef <br />CFO Owner Name: . <br />CFO City: . J CFO ZIP: . <br />San Joaquin County S <br />Environmental Health Department = <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 Z § <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd "5 <br />- <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) 3 > <br />SELF CERTIFICATION CHECKLIST gs <br />The following requirements are outlined in the Cottage Food Operations (CFO) regulations and are provided as minimum standar^ <br />of health and safety for the preparation of approved cottage foods in the home. I <br />CTO Business Name:Tk-Ui Sites, L-1 • C <br />CFO Address: <br />Ty. <br />7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or <br />household members are not included.) <br />6. Have all persons preparing or packaging CFO products completed the CDPH food <br />processor course?