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Example: <br />BIG CAKE BAKER <br />Stockton C. 95209 <br />Perm t= CL23.45 <br />&ski n: San iaqu n <br />Chocolate Chip Cookies with Walnuts <br />red ed t1•13""ine. <br />z 'Ziir. • ,:?lt triS t a". 5.itts'at <br />S...2 esrc ft artficie I vanilla evtrazt. isaKing soda <br />Contains: Wheal: rrilk, eggs, soy. <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05e.) <br />Note: For the 'Issued in County" - Identify 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 />lic Sewer Service LI Private Septic System <br />In the event of septic system failure or plumbing problem, you are required to notify <br />San Joaquin County Environmental Health Department immediately. <br />Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />irillRfame of Public Water System or Community Services District: city of ripon <br />LI 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 />Ei Bacteriological Test (quarterly*): <br />E] Nitrate Test (yearly*): <br />END 16-27 6/29/2023 4 <br />CFO REG/PERMITTING FORM