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Food Preparation items(includes packaging and handling): Yes No <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 /> 12. Warm water,hand soap and dean towels are available for hand washing. V6 ❑ <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. Q ❑ <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? ml Lmoe r <br /> During the preparation, packaging or handling of CFO products: Yes No <br /> 17. Domestic activities such as family meal preparation,dishwashing, clothes washing or ® Elironing,kitchen cleaning or guest entertainment are excluded from the kitchen. <br /> 18. Infants,small children,or pets are excluded from the kitchen. JQ ❑ <br /> 19. Smoking is excluded. 5 ❑ <br /> 20. Any person with a contagious illness shall refrain from work in the CFO. PQ ❑ <br /> Labeling Requirements: Yes No <br /> 21. A copy of the label has been submitted to this Department for review and approval. ❑ <br /> 22. 1 have attached a sample label. ❑ <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"C ss A"Cottage Food Operation. Prior to making any changes,I acknowledge that I must <br /> notify San Joaquin County vi nmentaI Health Department of any intended charges to the above statement. <br /> Cotta and Opera completed and submitted by: <br /> Signature Print Name Date <br /> EHD 162612272012 2 CFO CLASS A CHECKLIST <br />