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COTTAGE FOOD OPERATOR CHECKLIST COMPLETE <br />DATE: 12Jun2024 OWNER/OPERATOR: <br />ND SUBMITTED BY: <br />B8901770 <br />SIGN TM DRIVERS LICENSE,/ EXP DATE <br />BUSINESS TELEPHONE: 4089133930 4089133930 HOME TELEPHONE: <br /> <br />All food contact surfaces, equipment, and utensils used for the preparation, packaging. or <br />handling of any CIO products shall be washed, rinsed, and sanitized before each use. <br />All food preparation and food and equipment storage areas shall be maintained free of rodents <br />and insects. <br />Food Preparation Requirements (includes packaging and handling): <br />E <br />0 <br />Yes No <br />Hand washing is requires immediately prior to handling foods and after engaging in any <br />activity that contaminates the hands such as after using the toilet, coughing or sneezing, eating <br />or smoking. <br />Warm water, hand soap and clean towels are available for hand washing. <br />All food ingredients used in the CFO products are from an approved source. <br />Potable water shall be used for hand washing, ware washing and as an ingredient. <br />Is your water source a private water supply (well, spring, surface)? <br />a. If YES, have you completed testing for bacteria, nitrate & nitrite? <br />Is your water source a public water system or community services district? <br />E 0 <br />a. If YES, what is the name of the system or district? City of Tracy <br /> <br />During the preparation, packaging or handling of CFO products: Yes No <br />Domestic activities such as family meal preparation, dishwashing, clothes washing or ironing, <br />kitchen cleaning or guest entertainment are excluded from the kitchen. <br />Infants, small children (younger than 12 yr. old), or pets are excluded from the kitchen. <br />Smoking is excluded. <br />Any person with a contagious illness is prohibited from working in the CFO. <br />Labeling Requirements: Yes No <br />A copy of the label has been submitted to this Department for review and approval. 0 0 <br />I have attached a sample label. El CI <br />BY SIGNING BELOW YOU ARE CERTIFYING THAT YOU MEET THE REQUIREMENTS OF THE CALIFORNIA <br />HOMEMADE FOOD ACT, AB 1616 (GATTO), AS IT PERTAINS TO A "CLASS A" COTTAGE FOOD OPERATION. PRIOR <br />TO MAKING ANY CHANGES, I ACKNOWLEDGE THAT I MUST NOTIFY RIVERSIDE COUNTY DEPARTMENT OF <br />ENVIRONMENTAL HEALTH OF ANY INTENDED CHANGES TO THE ABOVE STATEMENT. <br />E-MAIL ADDRESS: czdegala@yahoo.com <br />Page 2 o12