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aroul"- SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax. (209) 464-0138 Web: www.siaov.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 />CSq B�nName: )� , CFOO er Name: O Li e— <br />I <br />CFO Address: CFO City: CFO ZIP: <br />/to 705,(!A 5%vel-T_n oto <br />Facility Requirements: Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br />0' <br />❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. <br />'0 <br />❑ <br />3. Additional storage used for the CFO will be within the home. <br />❑ <br />a. if YES, is the room used exclusively for storage? <br />❑ <br />❑ <br />b. Specify the room(s) that will be used for storage? ��-f� <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />❑ <br />Zoning Requirements: Yes No <br />5. 1 have complied with the applicable zoning requirements for the CFO. e ❑ <br />Employee and Training Requirements: Yes No <br />6. Have all persons preparing or packaging CFO products completed the CDPH food ❑ <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 El <br />members are not included.) <br />Sanitation Requirements: Yes No <br />8. Kitchen equipment and utensils used to produce CFO products are clean and ❑/ 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 <br />Elrodents and insects. <br />EHD 16-2612/27/2012 1 CFO CLASS A CHECKLIST <br />