Laserfiche WebLink
JOAQUIN <br />—COUNTY <br />Environmental Health Department <br />Example: <br />NUDE INA HOME KITCHEN <br />Permit i1: 12345 <br />Issued in county: County name <br />Chocolate Chip C'(Xtkies With \Calnnts <br />Salt Baker <br />123 Coltaue fixed Lie <br />Aim'here. CA rx)XCLX <br />Ingredients: Eunclxd flour IRhe,n flow. nixie, educed iron. dlumune, <br />uronolrimot. ribs flar'in and folic acid). bililel Imilk. xlll). Chocolole Clues <br />tsug;a. chlxvlate ulnar. cocoa muter, butiertat (milk). %alnun. suitor. epus. <br />soh. anilicml smrilln,SIrtKt. bukiuc xxla <br />Cantaim: \\Tent. end mule, soy. rcaianM <br />Net R7. 3 oz. (85.049g) <br />Note: For the 'Issued In County' - Idendly theludsdkffon (aWleounty) where you are obtaining approval. <br />6. Disposal of Waste: <br />Please c eck what type of treatment is used to dispose of waste <br />ublic 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 dentify the water source to be used in Cottage Food Facility (check one box) <br />ame of Public Water System or Community Services District: L&" <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 provi 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.cdph.ca-gov/programs[PaqesftbCoftageFood.aspx <br />4015 <br />