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Facility Requirements:Yes No <br />s □The CFO is located in a private dwelling where the CFO operator currently resides1. <br />s □2.All CFO food preparation will take place in the private kitchen within that home. <br />'S □Additional storage used for the CFO will be within the home.3. <br />0□If YES, is the room used exclusively for storage?a. <br />b. Specify the room(s) that will be used for storage? <br />4. <br />Yes NoZoning Requirements: <br />0 □5. I have complied with the applicable zoning requirements for the CFO. <br />Employee and Training Requirements:Yes No <br />6.□ <br />0 □If YES, copies of certificates are attached.a. <br />□□If NO, complete course within 3 months of CFO registration.b. <br />7.KI □ <br />YesSanitation Requirements:No <br />S □ <br />9.□ <br />0 □ <br />1EHD 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 />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 />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.org/ehd <br />CFO ZIP: <br />7^205 <br />CFO Owner Name: <br />TfistzA CV>\l<Xs <br />CFO City: <br />CFO CLASS A CHECKLIST <br />ini <br />Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />The following requirements are 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 />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 />□ <br />CFO Business Name: <br />£ I p 0- CoVY tJ x~<a <br />CFO Address: J