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NoFood Preparation Requirements (includes packaging and handling):Yes <br />□ <br />[x]□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?California Water <br />Yes No <br />□ <br />a □18. Infants,smallchildren, or pets are excluded from the kitchen. <br />□ <br />□ <br />Yes NoLabeling Requirements: <br />□21. A copy of the label has been submitted to this Department for review and approval. <br />0 □22. I have attached a sample label. <br />ture <br />2 CFO CLASS A CHECKLISTEHD 16-26 12/27/2012 <br />During the preparation, packaging or handling of CFO products: <br />17. Domesticactivities such as family meal preparation, dishwashing, clothes washing or <br />ironing,kitchen cleaning or guest entertainment are excluded from the kitchen. <br />19. Smokingisexcluded. <br />20. Anypersonwith a contagiousillnessshall refrain fromwork in the CFO. <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. <br />[Xl <br />E <br />E <br />E <br />Erin Kuhlman <br />Print Name <br />4/16/26 <br />Date <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 />Cottage Food Operator Checklist completed and submitted by: