Laserfiche WebLink
SAN JOAQUIN <br />—COUNTY- <br />Environmental Health Department <br />Example: <br />MI ADE IN A HOME EITCHEN <br />Permit N: 12345 <br />Issued In county. County name <br />Chocolate Chip Cookies With Walnuts <br />Sally Baker <br />123 College Food lame <br />Anywhere, CA 90\'XX <br />Ingredients: Enriched hour (Wheat flour. macia reduced iron. iltualiue. <br />uwnowuae, riboflavin and folic flair. bunter (milk, salt), chocolate chips <br />(sugar. chocolate liquor. cocoa butter. butterfat (milk). waimns, snear, eggs. <br />salt, artificial vanilla extract. baking soda. <br />Contains: Wheat, eggs, milk, say, walnuts <br />Net {5h. 3 oz (65.0490 <br />Note: For the -Issued in County --Identify Mejurisdiction (oitycounty) where you are obtaining approval. <br />6. Disoosai of Waste: <br />Please check what type of treatment is used to dispose of waste <br />Q 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 Escalon <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 Stale 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 />❑ Nfrite Test (every 3 years*): <br />*Additional information may be required N two 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 see CDPH vrebshe www,edoh.ca.aov/orooromNPaoes/rdbCottageFoodasmr <br />4 of <br />EHD 16-27 6/29/17 CFO REGIPERMIiTING FORM <br />