Laserfiche WebLink
SA N 110 A Q U l N Environmental Health Department <br /> COUNTY--- <br /> Example: <br /> NIADE In A HOME KITCHEN <br /> Permit 0: 1231,5 <br /> InoM In munq: County name <br /> Chocolate CWP CotlkieS Willi lValnms <br /> 123 Crnge FoM.l.nne <br /> Atkmlme,CA 90\:CX <br /> Ingrntlents: Emoted mmn(Al",firm,nindn.rahmcd iron.iluamine, <br /> lixi m ante.rilvilmin and folic will.tmm&(mill;,Sniq.clxxnbic cbiln <br /> (atg'in <br /> .dx+colme ligtmt,corn Innte,Imnnfnl(milk), wabnns.Sugar.eggs. <br /> &A.rtificial wlilla"taw.biking Safi, <br /> Contnln:Wheat.eltlt,m1114sole,naMuh <br /> \N\\Y.3 oz(U.019g) <br /> For the'Issued in CMZW-Idenft7y rho/tiftdidion(O@ytotmW whore you aro obtaining approval. <br /> 6. Disposal of Waste: <br /> Please check what type of treatment is used to dispose of waste <br /> VM Public Sewer Service ❑ Private Septic System <br /> In the event of septic system failure Or plum"problem,you am required to mb7y San Joaquin County Emdrortmental Health Department <br /> :rxrtemately. <br /> 7. Water Source: <br /> Pease ldentrfy 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.): IZ <br /> Prfvate Water Supply.initial Water quality Results <br /> Check boxes below if initial water testing has been completed. <br /> AD testing must be done at a State Certified Laboratory. Father attach lab results or provide name of lab.date 8 <br /> resufls 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 /> "Addxionat intermartbn may be requQed if Mod is prepared bom a home with a private water supply—died Mh 1=1 PAisdir2(on. <br /> 8. Food Processor Course: Initial if you agree to abide by the following: L V <br /> Within 3 months of being approved to operate by the Environmental Health Department, please provide proof <br /> of completion of the Cafrfomia Food Handier course in lieu of the California Department of Public Health <br /> (CDPH)food processor course. <br /> For more Information see CDPH websft wiaw <br /> 4 of <br /> EMD 16-27 MM7 CFO REGMSUU1TING FORM <br />