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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •i. <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <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 <br /> of health and safety for the preparation of approved cottage foods in the home. <br /> CFO Business Name: MuIc i`5 AYW1, CFO Owner Name: <br /> Scunlq In +c c' � _�C, . r 11�. t1V� <br /> CFO Addre -: CFO City: CFO ZIP: <br /> s D"_CLA. <br /> Facility Requirements: 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. �2Z/ ❑ <br /> 3. Additional storage used for the CFO will be within the home. LJJ ❑ <br /> a. If YES, is the room used exclusively for storage? �`4 114 lrJ <br /> b. Specify the room(s)that will be used for storage? Garu Li �S <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. d ❑ <br /> Zoning Requirements: Yes No <br /> 5. 1 have complied with the applicable zoning requirements for the CFO. ❑ <br /> Employee and Training Requirements: Yes No <br /> 6. Have all persons preparing or packaging CFO products completed the CDPH food 11processor course? <br /> a. If YES, copies of certificates are attached. ❑ Ed <br /> b. If NO,complete course within 3 months of CFO registration. [Jf ❑ <br /> 7. The CFO has no more than 1 full-time equivalent employee?(Immediate family or d 11household members are not included.) <br /> Sanitation Requirements: Yes No <br /> 8. Kitchen equipment and utensils used to produce CFO products are clean and d El <br /> 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 d ❑ <br /> rodents and insects. <br /> _T3 yw•eA� CO �4 12-2 OR z5 20 <br /> EHD 162612/272012 _/ 1 CFO CLASS A CHECKLIST <br />