Laserfiche WebLink
SANJ O A Q U I N Environmental Health Department <br /> — COUNTY— <br /> Example: <br /> MADE IN A HOME KITCHEN <br /> Permit 0: 12345 <br /> Issued In county: County name <br /> Chocolate Chip Cookies With Walnuts <br /> sally Baker <br /> 123 Cottage Food Lame <br /> Anywhere,CA 90,E <br /> Ingredients: Enriched flour(Wheat floor..mfaca reduced irou,thiamine, <br /> mononitrate,riboflavin and folic acid),butter(milk,salt),chocolate chips <br /> (sugar,chocolate liquor.cocoa butter,butterfat(milk), walnuts.sugar,eggs. <br /> sah.artificial vanilla n1ract,baking soda. <br /> Contains:lN6est,eggs,milk,soy,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 /> rUblic Sewer Service ❑ Private Septic System <br /> In the event of septic system failure or plumbing problem,you are required to notdy 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 /> Ee Name of Public Water System or Community Services District: C � Ie a <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 localjurisdiction. <br /> 8. Food Processor Course: Initial if you agree to abide by the following: 1,_qt <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.odph.ca.iiov/proaramsiPacfes/fdbCotteneFood.aspx <br /> 4 of <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />