Laserfiche WebLink
SANmJOAQUIN <br />COUNTY <br />Environmental Health Department <br />Example: <br />NLADE IN A HOME KITCHEN <br />Permit p: 12345 <br />Issued in county: County name <br />Chocolate Chip Coolies With Walnuts <br />Sally Baker <br />123 Cottage Food Lane <br />Anywhere, CA 90XXX <br />Ingredients: Enriched flour (Wheat flour, niacin, reduced iron, thiamine, <br />mouottitmte, nboflavhr and folic acid), butter (milk, salt), chocolate chips <br />(sugar, chocolate liquor, cocoa butter. butterfat (milk), walnuts. sugar, eggs. <br />salt, artificial vanilla extract, baking soda. <br />Contains: Wheat, 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 />❑ 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 />❑ Name of Public Water System or Community Services District: <br />® Private Water Supply**, Identify the source (well, spring, surface, etc.): Well <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*): IEH-JL Analytical, 10-27-2021, PASS <br />® Nitrate Test (yearly*): IEH-JL Analytical, 4 ^^ 'ry czvcr, PASS, 10-29-2021 <br />® Nitrite Test (every 3 years*): [EH -JL Analytical, 10-27-2424, PASS, 10-29-2021 <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: CE <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.edi3h.ca.gov/l3rograms/Pages/fdbCottaneFood.asox <br />4 of <br />EHD 16-276/29/17 CFO REG/PERMITTING FORM <br />