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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Permit#012345 <br /> Issued in: San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> Ingredients Enriched fbur(wheat flour,niacin,reduced iron,thiamine,mononitrate,riboflavin <br /> andfolic acid),butter(milk,salt,dhacolatechips(sugar,dnxolateliquor,mora butter,butterfat <br /> (milk),walnuts,sugar,eggs,sal;arbfiria Ivan illa extract,baking soda <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"-Identify the jurisdiction(city/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 /> 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 <br /> Depafiment immediately. <br /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> 'Ti Name of Public Water System or Community Services District: <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 corn''eted. <br /> All testing must be done at a State Certified Laboratory. Either attach lab results or provide name of lab,date& <br /> resuits 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 /> EHD 16-27 6/29/2023 4 CFO REG/PERMITTING FORM <br />