Laserfiche WebLink
SA N rJ O A Q U IN Environmental Health Department <br /> —COUNTY— <br /> Example: <br /> 'MADE IN A HO'NUE KITCHEN <br /> Permit th 12345 <br /> Issued In county: County name <br /> Chocolate Ctrip Cookies With Walnuts <br /> Sally Baker <br /> 123 Cottage Food Lute <br /> Anywhere.CA 90.1aN <br /> Ingredients: Enriched flour(Micat flour.tuaciu.reduced iron,thinnline. <br /> mononitmte,riboflavin and folic acid),butter(nulk.salt),chocolate chips <br /> (sugar,chocolate liquor,cocoa batter,butterfat(milk), walnuts,sugar,eggs. <br /> salt,artificial vanilla extract,baking sods. <br /> Contains:{Neat,eggs milk,soy,walnuts <br /> Net A9.3 oz(85.049g) <br /> Note:For the"Issued in County"-Identify the judsdiction(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: sanJoaquincountywater-lincolnvillageanddistrict <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: AR <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 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />