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SAN J O A O U I N Enm <br /> vlrmunental Health Depenent <br /> U IY Example: <br /> tint tit \ — <br /> I'andn- I:Nc <br /> hWrd In•uue H' 1 uwJ•uamr <br /> 1 Irlwtil+lc l L,p I nlvl1 tib V, hm. <br /> sdL il.dn <br /> br,n,hwh; inti ln�l l6 vl iU Ileal 16ul uusw 11111k ill"Il Ilnnndrc <br /> i vit.nc ul.11aun ml l .141J) burn nroll wdl i d.enl.de Jnh <br /> ,lues, J.�.1ih•uyu'1 ubnlm l.'"i glulk, u.dnpr, wnl c... <br /> •N .uninnl.nulla r\;I ul LJmlx wh <br /> (anlaim:\1 brat•rti mI1L vn,nalouh <br /> \rl R 1.J ot.fa.G.n+9Rl <br /> Note For the'Wued in Cwnry'-Identify the)unsdictron tedy/county)where you ere obtaining approval <br /> 6. Disposal of Waste: <br /> Please check what type oftreatrnent is used to dispose of waste <br /> LI Public Sewer Service ❑ Private Septic System <br /> In the even of septic system failure or plwnbmg 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 /> l <br /> t[i Name of Public Water System or Community Services District: a dy el{ rrQey <br /> ❑Private Water Supply", Identity the source(well,spring,surface,elcJ- <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 Cenlfied Laboratory Either attach lab results or provide name of lab.date& <br /> results in space provided next to type of test <br /> '1 Testing frequency for transient Non-Commumty Water Systems after Initial testing) <br /> ❑Bacteriological Test(quarterly'). <br /> ❑Nitrate Test(yearly? <br /> ❑Nitrite Test(every 3 years'). <br /> "Addlndral Infomation may ce mqumd If food a prepared from a home with a Private water supply-check with kcal jurisdiction <br /> B. Food Processor Course: Initial if you agree to abide by the following:--Z-- <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(CDPH) <br /> food processor course <br /> For more Information see CDPH website www cdmh cg g2yi mar ms/PaaeslfdbCollaaeFood asp+ <br /> .1,r <br />