Laserfiche WebLink
SANJOAQUIN <br />—COUNTY— <br />Environmental Health Department <br />Example: <br />MADE IN A HObtE IUTCHEN <br />Permit p: 12345 <br />Issued In county: County name <br />Chocolate Chip Cookies \Pith TValnuts <br />Sally Baker <br />123 Cottage Food Lane <br />All where. CA 90-10C <br />Ingredients: Etuicbed floor (\Miert flota, nincin. redtmed iron, tlt anutte. <br />ntononinve. ribonasin and folic acid). banter (milk, salt), chocolate clips <br />(sugar, chocolate liquor, cocoa butter, butterfat (hulk). walnuts. sugar. eggs. <br />salt. artificial vanilla extract. baking soda. <br />Contains: Wheat. eggs, milk soy, walnuts <br />..Not Wt. 3 oz (85.049g) <br />ote: For the 9ssued In County'- Ideni fy the jurisdiction (cMy/county) wires you are obtalntng approval. <br />6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />0 Public Sewer Service <br />❑ 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 />21 Name of Public Water System or Community Services District: C �� � � S+D cvdan <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: 2 <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.aov/oroaram$fttesMbCot%gaeFood aspx <br />4 of <br />EHD 16-27 8/29/17 CFO REG/PERMr TING FORM <br />