Laserfiche WebLink
SANJ O A Q U I N Environmental Health Department <br /> _.. .0L.)N T Y _ <br /> Example: <br /> MADE IN A HOME KITCIIEN <br /> Permit#: .12345 <br /> Issued in count`: Counts•mute <br /> Chocolate Chip Cookies With Wahuus <br /> Sally Baker <br /> 123 Cottaee Food Lane <br /> C <br /> Aiwwhere. :A 90\\\ <br /> Ingredients: kmiched flour(Wheat Motu,niacin,reduced iron.tlriannue. <br /> mononittare.ribol1nin mud folic acid).butter(urilk,yah).chocolate Chips <br /> (sugru,chocolate liquor.COCin boner.banerfat(Lrulk), wal alts.sugm,eggs. <br /> ,alt,artificial v nuilla exinier.bekiva soda. <br /> Contains:Wheat.eggs,milk.soy,walnuts <br /> Net AV(.3 oz.(85.049g) <br /> Note:For the"Issued in County"-Identify the jurisdiction(city/county)where you are obtaining approval. <br /> 6. Disposal of Waste: <br /> Please check what type of treatment is used to dispose of waste <br /> Public Sewer Service ❑ Private Septic System <br /> In the event of septic system failure or plumbing problem,you are required to notify San Joaquin County Environmental Health Department <br /> immediately. <br /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> ❑ Name of Public Water System or Community Services District: <br /> ❑ Private Water Supply**, Identify the source(well,spring,surface,etc.): <br /> Private Water Supply: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. Either attach lab results or provide name of lab,date& <br /> results in space provided next to type of test. <br /> *(Testing frequency for transient Non-Community Water Systems after initial testing) <br /> ❑ Bacteriological Test(quarterly*): <br /> ❑ Nitrate Test(yearly*): <br /> ❑ Nitrite Test(every 3 years*): <br /> -Additional information may be required if food is prepared from a home with a private water supply—check with local jurisdiction. <br /> 8. Food Processor Course: Initial if you agree to abide by the following: <br /> Within 3 months of being approved to operate by the Environmental Health Department,please provide proof <br /> of completion of the California Food Handler course in lieu of the California Department of Public Health <br /> (CDPH)food processor course. <br /> For more information see CDPH website www.cdph.ca.gov/programs/Pages/fdbCottageFood.aspx <br /> 4 of 5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />