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Food Preparation Requirements(includes packaging and handling): Yes No <br /> F <br /> ashing is required immediately prior to handling foods and after engaging in / ❑ <br /> tivity that contaminates the hands such as after using the toilet,coughing or Q <br /> ng, eating or smoking. ��// <br /> water,hand soap and clean towels are available for hand washing. L/J ❑ <br /> d ingredients used in the CFO products are from an approved source. E ❑ <br /> le water shall be used for hand washing, ware washing and as an ingredient. M El <br /> r water source a private well? ❑ 6d <br /> YES, have you completed testing for bacteria and nitrate? ❑ ❑ <br /> 16. Is your water source a public water system or community services district? sf ❑ <br /> a.If YES, what is the name of the system or district? ( �W C� -� <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 d ❑ <br /> ironing,kitchen cleaning or guest entertainment are excluded from the kitchen. <br /> 18. Infants, small children, or pets are excluded from the kitchen. ❑ <br /> 19. Smoking is excluded. [vf ❑ <br /> 20. Any person with a contagious illness shall refrain from work in the CFO. Rf ❑ <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. 2� ❑ <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 /> -3112- L-1 <br /> Signature Print Name Date <br /> EHD 16-26 17/27/2012 2 <br /> CFO C1A55 A CHECKLIST <br />