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c�.,A SAN JOAQUIN COUNTY <br /> + ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ry. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.oro/ehd <br /> COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br /> SELF CERTIFICATION CHECKLIST <br /> The following requirements aro outlined in the Collage Food Operations(CFO)regulations and em provided as minimum standards <br /> of health and safety for the preparation of approved cottage foods in the home. <br /> -CFO Business Name: CFO Owner Name: <br /> 1 <br /> kT_-TC_ RRm A SAfnvORALA <br /> CFO Address: CFO City: CFO ZIP: <br /> _"221_1 S POde 6 Def MnanbAkouse <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides 4ZEl <br /> ,,.,.....,,// <br /> 2. All CFO food preparation will take place in the private kitchen within that home. y� ❑ <br /> 3. Additional storage used for the CFO will be within the home. -E( ❑ <br /> a. - If YES, is the room used exclusively for storage? -er' ❑ <br /> b. Specify the room(s)that will be used for storage? k t ��e>1 And pct hw- <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. 42` ❑ <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 ❑ <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 ❑ <br /> household members are not included.) <br /> Sanitation Requirements: Yes No <br /> 8. Kitchen equipment and utensils used to produce CFO products are clean and �/ ❑ <br /> maintained 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 -2 ❑ <br /> rodents and insects. <br /> EHD 1626 1227/2012 1 CFO CLASS A CHECKLIST <br />