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Yes NoFacility Requirements: <br />□The CFO is located in a private dwelling where the CFO operator currently resides1 <br />All CFO food preparation will take place in the private kitchen within that home2 <br />Additional storage used for the CFO will be within the home3 <br />□ <br />dining roomb <br />4 <br />Yes NoZoning Requirements: <br />□I have complied with the applicable zoning requirements for the CFO.5 <br />Yes NoEmployee and Training Requirements: <br />E6□ <br />□If YES. copies of certificates are attached.a <br />E <br />7 E □ . <br />NoSanitation Requirements:Yes <br />8 B □ <br />I <br />9 □B <br />□B <br />CfOCLASS ACHtCKUSl1EHD 16-26 12/27/2012 <br />The CFO has no more than 1 full-time equivalent employee? (Immediate family or <br />household members are not included ) <br />Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair <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 />Specify the room(s) that will be used for storage? <br />Sleeping quarters are excluded from areas used for CFO food preparation or storage <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 />95377 <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.orq/ehd <br />B <br />□ <br />E <br />B <br />B <br />□ <br />□ <br />E <br />E <br />CFO Business Name <br />Oma s Cottage <br />CFO Address <br />984 Shelborne Dr <br />CFO Owner Name <br />Christel Gampig-Avila <br />CFO City <br />Tracy <br />10 All food preparation and food and equipment storage areas shall be maintained free of <br />rodents and insects <br />□ <br />The following requirements am 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 />a If YES, is the room used exclusively for storage? <br />b If NO, complete course within 3 months of CFO registration