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Food Preparation Requirements (includes packaging and handling): Yes No 11. Hand washing is required immediately prior to handling foods and after engaging in ❑ 22. any activity that contaminates the hands such as after wing the toilet, coughing or a ❑ sneezing, eating or smoking. 12. Warm water, hand soap and clean towels are available for hand washing. rA E4,❑ 13. All food ingredients used in the CFO products are from an approved source. R ❑ 14. Potable water shall be used for hand washing, ware washing and as an ingredient. 0 ❑ 15. Is your water source a private well? ❑ El a. If YES, have you completed testing for bacteria and nitrate? ❑ ❑ 16. Is your water source a public water system or community services district? ® ❑ a. If YES, what is the name of the system or district? Sar�c;cl q V, fr,qn 3 �,s�f eek -w During the preparation, packaging or handling of CFO products. 11 Yes No 17. Domestic activities such as family meal preparation, dishwashing, clothes washing or E9 ❑ ironing, kitchen cleaning or guest errtertainment are excluded from the kitchen. 18. Infants, small children, or pets are excluded from the kitchen. JZ ❑ 19. Smoking is excluded. IN ❑ 20. Any person with a contagious illness shall refrain from work in the CFO. 9 ❑ Labeling Requirements: Yes No 21. A copy of the label has been submitted to this Department for review and approval. ❑ 22. 1 have attached a sample label. a ❑ By signing below you are certifying that you meet the requirements of the California Homemade Food Act, AB 1616 (Gatto), as it pertains to a "Class A" Cottage Food Operation. Prior to making any changes, I acknowledge that I must notify San Joaquin County Environmental Health Department of any intended changes to the above statement. Cottage Food Operator Checklist completed and submitted by: �I(ayrC0 OS'—Ut-/-2022 S Print Name Date FHn 16 -?F 1?07on19 i CM M A55 A r.HFCKI IST