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8-May-Z0Z5 13:43 Uarsha Nandani Raj Z096934145 p.9 <br />Food Preparation Requirements (includes packaging and handling}:NoYes <br />0 <br />0 <br />Yes No <br />20. Any person with a contagious iilness shall refrain from work in the CFO. <br />Yes No <br />22. I have attached a sample label. <br />Cottage Food Operator Checkfet completed arid submitted by; <br />Fafrzre <br />.2EHD TB-TS 12/27/2012 CFO CLASS A CHECKLIST <br />18. Infants, small children, or pets sre excluded from the kitchen. <br />19. Smoking is excluded. <br />By signing below you ara certitying that you maef the requirements of the California Homemade Food Act, AB 1616 <br />(Gatto), as It pertains to a "Class A" Cottage Food Operation Prior to maklnQ any chanpes, I aoknou/lsdge thr*[ I must <br />notify San Joaquin County Environmental Health Department of any intended changes to ths above statement <br />nr <br />& <br />eK <br />qz” <br />-^41^ V <br />Charu Pandey__ <br />Prrtl Nume <br />Labeling Requirements; <br />I" 21. A copy of the label has been submitted to this Department for review and approval. <br />Date <br /> ! <br />11 Hand washing is required immediately prior to handling foods and after engaging in <br />any activity that contaminates the hands such as after using the toilet, coughing or <br />sneezing, eating or smoking. <br />12. Warm water, hand soap and clean towels are available for hand washing <br />13 All food ingredients used in the CFO products are from an approved source. <br />14 Potable water shall be used for hand washing, ware washing and as an ingredient. <br />15. Is your water source a private well? <br />a. If YES, have you completed testing for bacteria and nitrate9 <br />16. Is your water source a public water system or community services district? <br />a. If YES, what is the name of the system or district? <br />During the preperotion, packaging or handling of CFO product^: <br />17. Domestic activities such as family meal preparation dishwashing, clothes washing or <br />ironing, kitchen cleaning or guest entertainment are excluded from the kitchen.