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NUDE IN A HONIE HITCHEN <br /> Permit#: 12345 <br /> Issued to county. County name <br /> Chocolate Chip Cooties U-ith Walunts <br /> Sally Baker <br /> 123 Cottage Food lane <br /> Anywhere,CA 90.002 <br /> Ingredients: Euriched flour(Wheat flour,niacin.reduced iron-thiamine, <br /> mononitrate,riboflavin and folic acid),butter(milk,salt),chocolate chips <br /> (sugar.chocolate liquor,cocoa butter.butterfat(mill-). walnuts.sugar.eggs, <br /> salt,atti5cial vanilla exhnet,baking soda. <br /> Contains:Rieat.eggs,milk,soy,walnuts <br /> Net WL 3 oz(85.0498) <br /> Note:For the"Issued in County"-Identify the jurisdiction(cily/countyJ where you are obtaining approval. <br /> 6. Disposal of Waste: <br /> PPse check what type of treatment is used to dispose of waste <br /> �LV-/J, 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 /> P ase Identify the wafer source to be used in Cottage Food Facility(check one box) <br /> Name of Public Water System or Community Services District: &/V W /c7V4zix— <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 intonation 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.edoh.rawww�ov/orogramslPaueslfdbCotfageFood.asoxoroarams/PauesffdbCotfageFood.asox <br /> 4 of 5 <br /> EHD 16-27 6129117 CFO REG/PERMITfING FORM <br />