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as4 1 .� SAN JOAQUIN COUNTY <br /> z ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> iq 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> r . Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> %Oka i i tip= s-"%is LJ Wr-=Mjft s <br /> SELF CERTIFICATION CHECKLIST <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 approvedcottage foods in the home. <br /> CFO Busines Name: CFO Owner Name: <br /> -Cln ctw Auf <br /> CFO Address: CFO City: CFO ZIP: <br /> 5f�;b - M-Do Old Sh 01-fvo Ong I�__ <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides �Z ❑ <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 /> u�l.. Spe&y the Tcom(s'k Vt '1N`lh."be used ��,�«�1���c? <br /> Q apirl aa,& <br /> 4. Sleeping quarters are excluded from areas used for CFO food pr�on or storage. ❑ <br /> Zoning Requirements: Yes No <br /> 5. t have,complied with the applicable zoning requirements.for the CFO. X ❑ <br /> Employee and Training Requirements: Yes No <br /> 6. Have all persons preparing or packaging CFO products completed the CDPH food ❑ V1 <br /> processor course? <br /> a. If YES, copies of certificates are attached. ❑ ❑ <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.) K <br /> Sanitation Requirements: 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 /> I <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 I� ❑ <br /> rodents and insects. <br /> EHD 16-26 12/27/2012 1 CFO CLASS A CHECKLIST <br />