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a� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> XPi' Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/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 /> CFO Business Name: O Owner Name: <br /> ti Unelle dImpkn4rkf <br /> CFO Address: CFO City: 5 ZIP: <br /> L*ChI q 5 2 <br /> Facility Requirements: Yes No <br /> 1. The CFO is located in a private dwelling where the CFO operator currently resides d ❑ <br /> 2. All CFO food preparation will take place in the private kitchen within that home. ❑ <br /> 3. Additional storage used for the CFO will be within the home. ❑ <br /> a. If YES, is the room used exclusively for storage? ❑ <br /> b. Specify the room(s)that will be used for storage? Kiich'ein <br /> 4. Sleeping quarters are excluded from areas used for CFO food preparation or storage. [� ❑ <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, EJ <br /> 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 /> EHD 16-26 12/27/2012 1 CFO CLASS A CHECKLIST <br />