Laserfiche WebLink
SANJ O A Q U I N Environmental Health Department <br /> Example: <br /> MADE I\A HONTE KITCHEN <br /> Permit t:: 12341 <br /> Issued In counh: Counts name <br /> (llocolate Chip Cookies With\Caltrans <br /> Saliv Baker <br /> 123,Collage Food Line <br /> Auswhem CA 90YSS <br /> Ingredients: Eanched flour Mliew Ilow.niacin.reduced iron thiamine. <br /> mononitrate.riboflavin and folic acid).butter nuilk.salt.chocolate chips <br /> Isttear.Chocolate liquor.cocoa boner.b umfiat Uailk). onluurs.sugar.ege& <br /> salt.afiticual vanilla extract.baking soda. -- <br /> Contains:N1 heal.eggs,milk,soy.oalnuts <br /> Set\\'t.3 oz.(85.0498) <br /> Note:For the'Issued in County"-Identify the Jurisdiction(dty/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 /> [y�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 <br /> �one <br /> box) <br /> �/ � <br /> Name of Public Water System or Community Services District: U w1 Ind <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: <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 we CDPH website www.cdnh.ca.aoviorouramstpaaeslfdbCottaaeFood.asox <br /> 4of5 <br /> END 16-276/29/17 CFO REGIPERM17ING FORM <br />