Laserfiche WebLink
Metadata
Document management portal powered by Laserfiche WebLink 9 © 1998-2015 Laserfiche. All rights reserved.
SAN .,J O A Q U IN Environmental Health Department <br /> COUN7Y-- <br /> Example: <br /> NUDE IN A,HOME KITCHEN <br /> Permit#: 12345 <br /> Issued In county: County name <br /> Chocolate Clop Cookies With Walnuts <br /> Sally Baker <br /> 123 Conage Food Lane <br /> _Ax'ivhere.CA 90,VVX <br /> Ingredients: Enriched flour(Wheat floor,niacin,reduced iron.d9amine, <br /> monouitate.riboflavin and folic acid).butter(null:.salt).chocolate chips <br /> (sugar.chocolate liquor.cocoa butter.butterfat(nulk). walnuts.sugar,eggs, <br /> salt,attificial vanilla extract.baking sada. <br /> Contains:'A lreat,eggs,milk,say,walnuts <br /> Net Wt.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 /> ZPublic 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 bqx) <br /> Name of Public Water System or Community Services District: �. 5 <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.ciovlr)roaramslPaaesifdbCottageFood.aspx <br /> 4of5 <br /> EHD 16-27 6129117 CFO REGIPERMITTING FORM <br />