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Example: <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Permit:10:2345 <br />Issued in San Joaqu n County <br />Chocolate Chip Cookies with Walnuts <br />Irsgrecheras Enrr& ficis I•eatflo riaor, red‘ced Iron, tharrrta frau:roust*, ritoftimr <br />ar0 fthc acd), bater lents, sat:), cr °rotate rhos Isk.gar, cr,occiate (0003 bate', gutter. <br />walmts, sugar, eggs, salt, artfioal rar dla ee:racc, baktrg sp.tla <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />Note: For the 'Issued in County" - Identity the jurisdiction (city/county) where you are obtaining approval. <br />Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />P 'Public Sewer Service LI Private Septic System <br />In the event of septic system failure or plumbing problem, you are required to notify San Joaquin County Environmental Health <br />Department immediately, <br />Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />dName of Public Water System or Community Services District: <br />kn CoLtr- WAVcr___ <br />Ej 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 />111 Nitrate Test (yearly') <br />EHD 16.27 6129:2023 4 CFO REG:PERMITTING FORM