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Environmental Health Department <br />Yes NoFacility Requirements: <br />□The CFO is located in a private dwelling where the CFO operator currently resides 01. <br />All CFO food preparation will take place in the private kitchen within that home.0 □2. <br />□0Additional storage used for the CFO will be within the home.3. <br />0 □If YES, is the room used exclusively for storage?a. <br />Downstairs bedroomb. Specify the room(s) that will be used for storage? <br />Sleeping quarters are excluded from areas used for CFO food preparation or storage.□04. <br />Yes NoZoning Requirements: <br />I have complied with the applicable zoning requirements for the CFO.0 □5. <br />NoYesEmployee and Training Requirements: <br />6.□0 <br />□0If YES, copies of certificates are attached.a. <br />□□If NO, complete course within 3 months of CFO registration.b. <br />7.□0 <br />Yes NoSanitation Requirements: <br />0 □ <br />9.□0 <br />□0 <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjcehd.com <br />The CFO has no more than 1 full-time equivalent employee? (Immediate family or <br />household members are not included.) <br />The following requirements are outlined in the Cottage Food Operations (CFO) regulations and are provided as minimum standards of health <br />and safety for the preparation of approved cottage foods in the home. <br />CFO Business Name: <br />Namma Ooru Kadai <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 />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 Address: <br />1702 Stephanie St <br />CFO ZIP: <br />95337 <br />CFO Owner Name: <br />Adhithi Prabhuraj <br />CFO City: <br />Manteca <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 />SAN JOAQUIN <br />-COUNTY— <br />Greotness grows here.