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accompany it) <br />Labels, wrappers, inks, adhesives, paper, and packaging materials that come into contact with the <br />cottage food product by touching the product or penetrating the packaging must be food-grade <br />(safe for food contact) and not contaminate the food <br />"-Example: <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Pe rm 55 012345 <br />Issued in San Joaquin County <br />Chocolate Chip Cookies with Walnuts <br />IrtgreaiertN truldled f tate ituh flour, Noon, retteed iron. thernne, monctutrate, <br />and folic acia butter Irne, salt), &accrete bins (wax, &cutlet' lsr cocoa butter, butterfat <br />(mak), walruts, stgar. aus, salt. artillual vanilla atria, WU% soda <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />/Vole For the 'Issued in County'- identify the junsdiction (cay/county) where you are obtaining approval <br />ailp9Sa I 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 />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: C l`ci Ot i,7 1-'o(77: <br />Private Water Supply —, Identify the source (well, spring, surface, etc.): <br />Private Water Supply: Initial Water Quality Results <br />Chock 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 aftor initial testing) <br />Bacteriological Test (quarterly'): I