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SAN,?,]0 A OU IN Environmental Health Department <br /> —COUNTY— <br /> Example: <br /> MADEIN A HO\1E h7TCHEN' <br /> Permit a: 12345 <br /> Issued In munly: County name <br /> Closeable clip Cookies with NAW nms <br /> Salkanker <br /> 123 Cottage Foal Lot. <br /> Any,here CA 90.11' <br /> ingled4nn: Ehridhed Oau(Plxniftoirt.dx�reduediirea lMnudn<. <br /> umna insw riboflalin mud folic acid),bnner(milk.salt),dhueuhte clips <br /> (sugar.c1molate liquor,cans Miner.butterfat(milk), uatnum sugar,eggs. <br /> salt,onifidnl ranillo csnasr,baking sada. <br /> Contains:R3ta1,eggs,sunk soy,oalnutx <br /> Net\\h.3 oz(&.0199) <br /> M&For the Issued M C%aW•IderrW Use%unsdction(city1com"where you are obtaining approval <br /> 6. Disposal of Waste: <br /> Pie se check what type or treatment is used to dispose of waste <br /> Publlc Sewer Service ❑Private Septic System <br /> n the event of septic system falure or plumbing problem,you are required to notly San Joaquin County Envinsrunentel Health Department <br /> h—edstaty. <br /> 7. Water Source- <br /> Pease identify the watersource to be used In Cottage Food FacIF4(check one box) <br /> ❑Name of Public Water System or Community Services District nYR/f& � f/ <br /> ❑Private Water Supply',Identify the source(well,spring,surface,etc.): <br /> Private Water Suppir..Initial Water Quality Results <br /> Check boxes below H initial water testing has been completed. <br /> All testing must be done at a State Certified Laboratory. Either attach tab results or provide name of tab,date S <br /> results in space provided next to type of test <br /> *(Testing frequency for transient Non-Commlmiry Water Systems after Initial testing) <br /> ❑Bacteriological Test(quarterly): <br /> ❑Nitrate Test(yearly): <br /> ❑Nitrite Test(every 3 years'): <br /> "AddWol information may be required H fwd is prepared from a tarns wNh o pMetg voter supply-check will toralludsdk8om <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 Cal'domia Food Handler course in lieu of the California Department of Public Health <br /> (CDPH)food processor course. <br /> For more ldormation see CDPH missile�rdslh.cnoov/txoaramslPaaealfdtsGaltaaeFnod.eamcnoov/proaramslpaaeNtdDCaltaaeFood.esln <br /> 4 of <br /> EHD 18.17 snail) CFO REONERMIRIRO FOFdd <br />