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Yes No KI □ Noes □ Labeling Requirements:No 2LHO )6 2b 12^7/2012 C>0 CLASS ACHLCKLISI 21. A copy of the label has been submitted to this Department for review and approval 22 I have attached a sample label 0 0 12 0 □ □ □ □ □ By signing below you are certifying that you meet the requirements of the California Homemade Food Act. AB 1616 (Gatto), as it pertains to a 'Class A' Cottage Food Operation. Prior to making any changes. I acknowledge that I must notify San Joaquin County Environmental Health Department of any intended changes to the above statement □ □ s □ □ □ E □ □ Cottage Food Operator Checklist completed and submitted by Signature Prir/l Name Yes ■a Date During the preparation, packaging or handling of CFO products: 17 Domestic activities such as family meal preparation, dishwashing, clothes washing or ironing, kitchen cleaning or guest entertainment are excluded from the kitchen. 18 Infants, small children, or pets are excluded from the kitchen. 19 Smoking is excluded 20 Any person with a contagious illness shall refrain from work in the CFO Food Preparation Requirements (includes packaging and handling): 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 eating or smoking 12 Warm water, hand soap and clean towels are available for hand washing 13 All food ingredients used in the CFO products arc from an approved source 14 Potable water shall be used for hand washing, ware washing and as an ingredient 15 Is your water source a private well? 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?