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- - - . - Made In Home Kitchen COU N T Y-- permit#12345 Issued in County: San Joaquin County Dozen Vanilla Cupcakes 222 W. La Flor Ln. Mountain House CA, 95391 Ingredients: Enriched flour bleached (wheat flour, niacin, iron, thiamin mononitrate, riboflavin, folic acid), butter, sugar (milk salt), confectioners sugar, eggs, baking soda, baking powder artificial vanilla extract Contains:Wheat, eggs, milk Net Weight 6.50 oz (184.272 g) Note:For the"Issued in County"-identify the jurisdiction(city/county)where you are obtaining approval. 6. Disposal of Waste: Ple ae check what type of treatment is used to dispose of waste Sewer Service ❑ Private Septic System In the event of septic system failure or plumbing problem,you are required to notify San Joaquin County Environmental Health Department immediately. 7. Water Source: [Pe se Identify the water source to be used in Cottage Food Facility(check one box) Name of Public Water System or Community Services District: �i a--la 0 C 1 ►-u � ❑ Private Water Supply—, Identify the source (well, spring, surface,etc.): Private Water Supply.Initial Water Quality Results Check boxes below if initial water testing has been completed. All testing must be done at a State Certified Laboratory. Either attach lab results or provide name of lab,date& results in space provided next to type of test. '(Testing frequency for transient Non-Community Water Systems after initial testing) ❑ Bacteriological Test(quarterly*): ❑ Nitrate Test(yearly*): ❑ Nitrite Test(every 3 years*): "Additional information may be required if food is prepared from a home with a private water supply—check with local jurisdiction. 8. Food Processor Course: Initial if you agree to abide by the following: Within 3 months of being approved to operate by the Environmental Health Department, please provide proof of completion of the California Food Handler course in lieu of the California Department of Public Health (CDPH) food processor course. For more information see CDPH website www.cdph.ca.goviprograms/PageslfdbCottageFood.aspx A of ;