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Example: <br />BIG CAKE BAKER <br />Stockton CA 952C9 <br />Perm t C12345 <br />ssued n San Joaqu -n County <br />Chocolate Chip Cookies with Walnuts <br />Ingredierts Enriched flcur lv,heat flour, riacir, reduced iron, therm!. e, mcr :nitrate, ribcfla,ir <br />and fclic acid;., butter Imilk, saIt. chccclate chip 'sugar, chocclate lisucr, cocoa butter, butterfat <br />I milk;, ‘...•al ruts, sugar, errs, salt arlificiaharilla extract, baking soda <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.03g) <br />Note For the "Issued in County" - Identify the junsdiction (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 />(g1 Public Sewer Service 0 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 />Name of Public Water System or Community Services District: ok-4 Leh e <br />0 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 />0 Bacteriological Test (quarterly') <br />D Nitrate Test (yearly') <br />EHD 16-27 6/29/2023 4 CFO REG/PERMITTING FORM <br />tvlft