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SAN JOAQUIN COUNTY <br />[ NVIRoNMENTAL HEALTH DEPARTMENT <br />1868 East Hazetton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468 3420 Fax: (209) 464-0138 With: www.thgov.org/eM <br />COTTAGE FOOD OPERATIONS (CFOs-CLASS A) <br />SELF CERTIFICATION CHECKLIST <br />The following requirements are outlined in the Cottage Food Operahons (CFO) regulallon$ aid IWO propleloal es ativIrnam standards <br />of health and safety for the preparation of approved cottage Mods in the home. <br />CFO Business Name CFO Owner Name: <br />Mabuhay Grindz <br />Christina Deciala and Russeg negate <br />CFO Address: CFO City. CFO ZIP: <br />1622 Dooston Ave Tracy 95377 <br />Facility Requirements: <br />The CFO is located in a private dwelling where the CFO operator currently resides <br />All CFO food preparation will take place in the private kitchen within that home. <br />Additional storage used for the CFO will be within the home. <br />If YES, is the room used exclusively for storage? <br />b. Specify the room(s) that will be used for storage? <br />Sleeping quarters are excluded from areas used for CFO food preparation or storage. <br /> <br />Zoning Requirements: Yes No <br />5. I 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 />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 preparation and food and equipment storage areas shell be maintained free of <br />rodents and insects. <br />END 18-26 12127/2012 1 CFO CLASS A CHECKLIST