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SA N 10 A Q U I N Environmental Health Department COUNTY Food Preparation Requirements(includes packaging and handling): Yes No 11. Hand washing is required immediately prior to handling foods and after engaging in any activity that contaminates the hands such as after using the toilet, coughing or sneezing, Yes eating or smoking. 12. Warm water, hand soap and clean towels are available for hand washing. Yes 13. All food ingredients used in the CFO products are from an approved source. Yes 14. Potable water shall be used for hand washing,ware washing and as an ingredient. Yes 15. Is your water source a private well? No 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? Tracy During the preparation, packaging or handling of CFO products: Yes No 17. Domestic activities such as family meal preparation,dishwashing, clothes washing or Yes ironing, kitchen leaning or guest entertainment are excluded from the kitchen. 18. Infants, small children, or pets are excluded from the kitchen. Yes Yes 19. Smoking is excluded. 20. Any person with a contagious illness shall refrain from work in the CFO. Yes Yes No Labeling Requirements: 21. A copy of the label has been submitted to this Department for review and approval_ Yes Yes 22. 1 have attached a sample label. By signing belov+you are certifying that you meet the requirements of the California Homemade Food Act,AB 1616(Gatto), as rt pertains to a Conmental Health pePartr�pnent of any intended chration. Prior to la ages tot e changes, above statementge mat 1 must notify San Joaquin County En Cottage Food Operator Checklist completed and submitted by Q5f02J21}24 Annapoorani Srinivasa Signature Print Name Date 2 of 3 c1-0 CLASS A c.11ECKLMT 1iJU 16•266,19,17