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Yes NoFood Preparation Reuirements (includes packaging and handling): 11. Hand washing is required immediately prior to handling foods and after engaging in any activity that contaminates the hands such as after using the'toilet, coughing.or sneezing, eating or smoking. 12. Warm water, hand soap and clear.towels are available for hand washing. ❑ 13. All food in9 redients an approved.in the CFO products are from aapproved.source. El 14. Potable water shall be'used for hand washing, ware washing and as an ingredient.. [] E 15. Is your water source a,private well? ❑ a.If YES, have you completed testing for bacteria and nitrate?, �❑ 16. Is your water source a public water system or community services district? El a.if YES, what isthe name of the system or district? During the preparation, packaging or handling of CFO products: es No 17. Domestic activitiessuch as family meal preparation,dishwashing, clothes washing or ironing, kitchen cleaning or guest entertainment are excluded from the:kitchen. _. ' ❑ 18. Infants, small children, or pets are excluded from,the kitchen. ' ❑ 19. Smoking is excluded. - ❑ 20. Any person with a contagious illness shall refrain from work in the CFO. ., � ❑ Labeling Requirements: Yes No 21. A copy of the label has been submitted to this Department for rev_iew and approval. FUr ❑ - 22. 1 have attached a sample label. ❑ i[. By signing below you are certifying that you meet the requirements of the-California Homemade Food Act, AB 1616 (Gatto), as it pertains to a"Class A" Cottage Food Operation. Prior to making any changes, i acknowledge that l must notify San Joaquin County Environmental Health Department of any intended changes to the above statement. Cottage Food Operator Checklist completed and submitted by: I . i # Signat re Print Name Date EHE 16-26 12/27/2012 2 CFO CLASS A`-CHECKLIST