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5. I have complied with the applicable zoning requirements for the CFO. El <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.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: <br />, (A-NV ir k_Ak C' try\ , e,,„(-1.A.,), <br />CFO Owner Name: <br />,`_c <br /> <br />CFO Addiess: I () <br /> <br />7C Li Oh.ei I C4- . <br />CFO Cite: CFO ZIP: <br />Facility Requirements: Yes No <br /> <br />1. The CFO is located <br /> <br />2. All CFO food prepiaration <br /> <br />3. Additional storage <br />If YES, is <br />Specify the <br /> <br />4. Sleeping quarters <br />in a private dwelling where the CFO <br />will take place in the private <br />used for the CFO will be within the <br />the room used exclusively for storage? <br />room(s) that will be used for storage? <br />lare excluded from areas used for CFO <br />operator currently resides VI. LII <br />kitchen within that home. Z <br />home. IIJ X <br />C (0 .€7,k- _ D tAiw -e..i- si-r-ivs,1 b <br />food preparation or storage. X El <br />Zoning Requirements: <br />Yes No <br />Employee and Training Requirements: <br />Yes <br />6. Have all persons preparing or packaging CFO products completed the CDPH food <br />processor course? <br />If YES, copies of certificates are attached. <br />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 />Kitchen equipment and utensils used to produce CFO products are clean and <br />maintained in a good state of repair. <br />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 />All food preparatio9 and food and equipment storage areas shall be maintained free of <br />rodents and insect*. El <br />EHD 16-26 12/27/2012 <br />CFO CLASS A CHECKLIST <br />)re0 net <br />°CCiCeQ) <br />fcA <br />SO <br />r- <br />No kOtit511,1.C5