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` - <br /> ' <br /> NLI�Df!N A H01 IE KITCHEN <br /> ls%ued in county: Count.v name <br /> Note:Forthe"Issuedin County"-Identify the jurisdiction(city1county)whereyou are obtaining approval. <br /> 0' Disposal of Waste: <br /> Please check what type oytreatment is used todispose ofwaste <br /> SrPub|kcSewer Service FlPrivate Septic System <br /> mthe event of septic system failure or plumbing problem,you are required to notify San Joaquin County Environmental Health Deparanent <br /> immediately. <br /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> Name ofPublic Water System orCommunity Services District: <br /> Private Water Supply-, Identify the source(well, spring, surface,etc.): <br /> Private Water aupp1jr.Initial Water Quality Results <br /> Check boxes below if initial water testing has been completed- <br /> All testing must be done at a State Certified Laboratory. <br /> omp|ated-8||teningnnuotbodonoatoStooaCartifiedLaboratom Either attach lab results orprovide name oflab,date& <br /> results inspace provided next totype oftest. <br /> *(Testing frequency for transient Non'CummunityVVoter Systems after initial testing) <br /> nBacteriological Test(quartor|y~): <br /> El Nitrate Test(yearly*)-. <br /> 0Nitrite Test(every 3yemm°): <br /> -Additional information may»erequired nfood isprepared from ahome with aprivate water supply-check with local jurisdiction. <br /> 8' Initial if you agree bmabide bythe following:19 <br /> Within 3 months of being approved to operate by the Environmental Health Department, please provide proof <br /> of completion of the California Food Handier course in lieu of the California Department of Public Health <br /> (CDPH)food processor course. <br /> For more information see oopnwebsite <br /> EHID 16-27 6/29117 CFO REG/PERMITTING FORM <br />