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-If Yes, submit a copy of microbiological (total coliform) analysis of the private well water that is conducted using samples collected no earlier than 60 days prior to the filing date of this application. -If No, submit a copy of most recent water bill for the location of the cottage food kitchen. I am a certified food protection manager in good standing with the accredited program. I attach a true copy of my food protection manager certificate or other proof of my credential. I am aware that my gross annual sales from cottage food products cannot exceed $50,000. If this is an application to renew my existing cottage food operator permit, I represent that in the past year, gross sales receipts from cottage food products did not exceed $50,000. Photocopies of original records that I am submitting with this application are true, complete, and correct copies of the original records. I certify that the statements I make in this application are true. I am aware that if any statement I make in in this application is willfully false, I am subject to civil administrative penalties under N.J.A.C. 8:24-8.9, denial of my application and/or revocation of my permit. By typing my name below, I intend to sign this Application for Cottage Food Operator Permit. Name of Applicant: ______________________________________________ Date: ____________________ SECTION IV – APPLICANT REPRESENTATIONS AND CERTIFICATION Application for Cottage Food Operator Permit (continued) Page 2 of 3 Facility Requirements The cottage food operation is in a private dwelling where I reside. All cottage food products are prepared in the private kitchen within my home. Sleeping quarters are excluded from areas used for cottage food preparation and storage. Sanitation Requirements Handwashing facilities are conveniently located, accessible, and supplied with warm running water, soap, and clean paper towels Kitchen equipment and utensils used for cottage food preparation are clean and in good repair. Food contact surfaces are cleaned and sanitized before each use. The premises are maintained free of rodents and insects. Cottage Food Preparation and Packaging Requirements Food workers wash their hands before working with food, and after any activity that contaminates the hands such as after using the restroom, eating, smoking, or touching pets. Food workers do not handle ready-to-eat food with their bare

working with food, and after any activity that contaminates the hands such as after using the restroom, eating, smoking, or touching pets. Food workers do not handle ready-to-eat food with their bare hands. Single-use gloves, tongs, or other effective means are used. If used, single-use gloves are changed or replaced as often as handwashing is necessary. Limitations/Exclusions During Cottage Food Preparation and Packaging Domestic activities such as family meal preparation, dishwashing, clothes washing, and kitchen cleaning are not conducted. Infants, children and pets are excluded from the kitchen. Potable drinking water is used for handwashing and warewashing, and as a cottage food product ingredient. Smoking is prohibited. Ill food workers are excluded from the kitchen. Prerequisite Information I have checked with my local municipal government and there are no local ordinances or zoning requirements that would prevent me from operating a home-based food business. Does the cottage food kitchen use private well water?CFO-1CFO-1 FEB 25