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Food Preparation Requirements (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 El <br /> sneezing, eating or smoking. <br /> 12. Warm water, hand soap and clean towels are available for hand washing. [DI' ❑ <br /> 13. All food ingredients used in the CFO products are from an approved source. 12" ❑ <br /> 14. Potable water shall be used for hand washing, ware washing and as an ingredient. E ❑ <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? �1�1 Yes No ur �roxcC <br /> During the preparation, packaging or handling of CFO products: <br /> 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or ❑ <br /> ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. <br /> 18. Infants, small children, or pets are excluded from the kitchen. Q� ❑ <br /> 19. Smoking is excluded. [� ❑ <br /> 20. Any person with a contagious illness shall refrain from work in the CFO. [9/ ❑ <br /> Labeling Requirements: Yes No <br /> 21. A copy of the label has been submitted to this Department for review and approval. z' 1:122. 1 have attached a sample label. Lg ❑ <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"Class A" Cottage Food Operation. Prior to making any changes, I acknowledge that I must <br /> notify San Joaquin County Environmental Health Department of any intended changes to the above statement. <br /> Cottage Food Operator Checklist completed and submitted by: <br /> A/vIl <br /> Dile-, rroi <br /> Signature Print Name Date <br />