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Environmental Health Department <br />Noes <br />_ot_ <br />No <br />Yes No <br />Date <br />2 of 3I-UD 16-26 6/29/17 CEO CLASS A CHECKLIST <br />SAN JOAQUIN <br />COUNTY <br />Signature <br />Labeling Requirements: <br />21. A copy of the label has been submitted to this Department for review and approval. <br />I <br />22. I have attached a sample label. <br />13. All food ingredients used in the CFO products are from an approved source. \j£5 <br />14. Potable water shall be used for hand washing, ware washing and as an ingredient. x| -CS <br />15. Is your water source a private well? O <br />By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 (Gatto), <br />as it pertains to a “Class A" Cottage Food Operation. Prior to making any changes, I acknowledge that I must notify San <br />Joaquin County Environmental Health Department of any intended changes to the above statement. <br />Cottage Food Operator Checklist completed and submitted by: <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? C j-Vlj ofc- I A>dj <br />Dunng the preparation, packaging or handling of CFO products: <br />17. Domestic activities such as family meal preparation, dishwashing, clothes washing or XJ-CS <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. ' <br />18. Infants, small children, or pets are excluded from the kitchen. <br />19. Smoking is excluded. x|£S <br />20. Any person with a contagious illness shall refrain from work in the CFO. <br />Food Preparation Requirements (includes packaging and handling): <br />11 Hand washing is required immediately prior to handling foods and after engaging in any <br />activity that contaminates the hands such as after using the toilet, coughing or sneezing, <br />eating or smoking. <br />12 Warm water, hand soap and clean towels are available for hand washing.