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" Miff, <br />if SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205.6232 <br />y <br />Telephone: (209) 468-3420 Fax: (209) 464.0138 Web: www.s gov.orci/ehd <br />COTTAGE FOOD OPERATIONS (CFOs -CLASS A) <br />SELF CERTIFICATION CHECKLIST <br />The following requirements are outlined in the Collage Food Operations (CFO) regulations and am provided as minimum standards <br />of health and safety for the pmpamtmn of approved college foods in the home <br />CFO Business Name CFO Owner Name - <br />a Freese VvY1 Kr-"_jSklR_ Ulr� >1t' <br />CFO Address CFO City: CFO ZIP. <br />Ms CA -CVA -e(%6%'1 \-Y lIkTV\"P gs33o <br />Facility Requirements: Yes No <br />1. The CFO is located in a private dwelling where the CFO operator currently resides <br />® <br />❑ <br />2. All CFO food preparation will take place in the private kitchen within that home. <br />® <br />❑ <br />3. Additional storage used for the CFO will be within the home. <br />® <br />❑ <br />a. If YES, is the room used exclusively for storage? <br />❑ <br />b. Specify the room(s) that will be used for storage? 06t,\en <br />4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br />[� <br />❑ <br />Zoning Requirements: Yes No <br />5. 1 have complied with the applicable zoning requirements for the CFO. 1t]� ❑ <br />Emolovee 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. ❑ 0, <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 ❑ <br />rodents and insects. <br />EHO 1626 1227/2012 1 CFO CLASS A CHECKLIST <br />