Laserfiche WebLink
SAN10 A Q U I N Environmental Health Department + <br /> COUNTY <br /> Example: <br /> NLADE IN A HONIE KITCHEN <br /> Permit#: 12345 <br /> Issued in county: County name <br /> Chocolate Chip Cookies With lvValuuts <br /> Salk'Baker <br /> 12;Cottage Food Lane <br /> An3ivhere,CA 90.30CX <br /> Ingredients: Enriched flop(Wheat flour,niacin.reduced iron.thiamine, <br /> monouiti-ate,riboflawu and folic acid),butter(milk,salt),chocolate chips <br /> (sugar,chocolate liquor,cocoa butter,butterfat(milk-), walnuts,sugar,eggs, <br /> salt,artificial vanilla extract,baking soda. y� <br /> Contains:Wieat,eggs.milk,soy,walnuts <br /> Net AN't.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: Q:[ <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.cdpli.ca.gov/programs/Pages/fdbCottageFood.aspx <br /> r <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />