Laserfiche WebLink
SANJ O A Q U I N Environmental Health Department <br /> Example: <br /> MADE IN A HOME KITCHEN <br /> Permit N: 1234., <br /> Issued In county: County name <br /> Chocolate Chip Cookies Willi Walnuts <br /> Sally Baker <br /> 123 Cottage Food Lane <br /> An3nvhere,CA 90A'K.X <br /> Ingredients: Emiched flour(Wheat flour,niacin,reduced imn,Ilumume. <br /> numoninate,ribollaviu and folic acid),buller(milk.sail),chocolate clips <br /> (sugar,chocolate liquor,cocoa butter,butterfat(milk), walnuts.suer,eggs. <br /> salt,artificial vamrilln extract,baking soda. <br /> Contains:Whent,eggs,milk,soy,walnuts <br /> Net XVI.3 oz.(82,.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 ❑ 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: City of Tracy <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: 4f4 <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.ca.goviprograms/Pages/fdbCottageFood.aspx <br /> 4 of <br /> EHD 16-27 6/29117 CFO REG/PERMITTING FORM <br />