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SAN „10 A Q U (N Environmental Health Department <br />--COUNTY <br />COTTAGE FOOD OPERATIONS (CFOs -CLASS A) <br />SELF CERTIFICATION CHECKLIST <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: CFO Owner Name: <br />Tl�i�nK eu 'To - � f V-A 0 <br />CFO City: CFO ZIP: <br />CFO Address <br />6112- ttivtV_ grr..o D1R- • l IK1t�cP °133 i) <br />Facility Reauirements: <br />Yes No <br />1, The CFO is located in a private dwelling where the CFO operator currently resides ® ❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. ® ❑ <br />3. Additional storage used for the CFO will be within the home. ® ❑ <br />a. If YES, is the room used exclusively for storage? ® ❑ <br />b. Specify the room(s) that will be used for storage? KrqVkTT4 r_K1WrS <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. ❑ <br />Zoning Requirements: Yes No <br />5. I have complied with the applicable zoning requirements for the CFO. ® El <br />Employee and Training Requirements: Yes No <br />6. Have all persons preparing or packaging CFO products completed the CDPH food ❑ 19 <br />processor course? <br />a. If YES, copies of certificates are attached. ❑ 1. <br />b. If NO, complete course within 3 months of CFO registration. ❑ <br />7. The CFO has no more than 1 full-time equivalent employee? (Immediate family or ❑ <br />household members are not included.) <br />Sanitation Requirements: <br />Yes No <br />8. Kitchen equipment and utensils used to produce CFO products are clean and ❑ <br />maintained in a good state of repair. <br />9. 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 />10. All food preparation and food and equipment storage areas shall be maintained free of ❑ <br />rodents and insects. <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjcehd.com <br />