Laserfiche WebLink
SANJOAQU1N <br />----COUNTY <br />Environmental Health Department <br />Example: <br />MADE IN A 1:10NE KITCHEN <br />Permit #: 12345 <br />issued in county; County name <br />Chocolate Chip Cookies With Walnuts <br />Salty Baker <br />123 Cottage Food Lane <br />:Anywhere. CA 90XXX <br />Ingrcdien4; Etwiched flour (Wheat flour, ittaun reduced iron,Iltrunme <br />11101160in ate, riboflavin and folic acid). butter (milk, salt), chocolate chips <br />(sugar, chocolate liquor, cocoa butter, liuttertin .4 Walnuts, sugar, eggs, <br />salt, artificial vanilla extract, bakinQ soda, <br />Contains: Wheat, eggs, milk, soy, walnuts <br />Net Wt. 3 oz. (8,5.9.190 <br />Note: For the "Issued in County"- Identify the jurisdiction (city/county) where you are obtaining approval. <br />6. Disposal of Waste: <br />P le4 se check what type of treatment is used to dispose of waste <br />Public Sewer Service CI 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: P <br />1 <br />ase Identify the water source to be used in Cottage Food Facility (check one box) <br />Name of Public Water System or Community Services District: CiAl t)f iljanktot, <br />CI 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 />CI Bacteriological Test (quarterly"): <br />CI Nitrate Test (yearly*): <br />CI 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 see CDPH website www.cdph.camov/programs/Pages/fdbCottaqeFood.aspx <br />4 of 5 <br />EHD 16-27 6/29/17 CFO REG/PERMITTING FORM