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Example: <br /> BIG CAKE BAKER <br /> StoL kton CA 95209 <br /> Pr mi It a 0 121 d 5 <br /> ,!,7_.ed rn San Joaquin Count <br /> Chocolate Chip Cookies with Walnuts <br /> �" rWArt1 Emcmfa4 C l o'e.4 rltw,•,ry it;r,rpG etl+reR th-j^r4 9"Gh.tnnk rfDCRaeo <br /> and{d[at4r btigulf 1^111 IBM mix Duns,o4p In.;rr c ccdsiel.,2:.0. cocosbLe'e W--&-fo <br /> 1-dp.valm:L,AgV fU&&sit aT1i.C41Y3rdLa vdtxi-baurq�G <br /> Contains: Wheat. milk.eggs. soy, walnuts <br /> Made to a home kitchen <br /> Net Wt. 3 oz. (85.059) <br /> Note For the'issued in CounV-fdenbfy the Junsdictlon(cWcounty)where you are obtaining approval. <br /> 6. Disposal of Waste: <br /> Pleas check what type of treatment is used to dispose of waste <br /> ub4c Sewer Service ❑ Private Septic System <br /> In the event of septic system lailuto or plumbing problem,you are required to notify San Joaquin County Environmental Health <br /> t]epatrtmenl immediately <br /> T. Water Source: <br /> Pea. denbly the wafer source to be used in Coffage Food Facility(check one box) <br /> Name t of Public Water System or Community Services District: SA-ae.�C�t�l <br /> ❑ Private Water Supply". Identify the source (well, spring, surface,etc.)- <br /> Prlrale Water Supply:lnilfal Water Quality Results <br /> t tx"boxds below If initial water les<bng has been completed <br /> AN Wafing must be done at a Stato Certifiud Laboratory. Either attach lab results or provide name of lab,date& <br /> reeutm in space provided noxi to type of test. <br /> 4(Ttlstsrlg frequency for transient Non-Community Water Symtems after initial testing) <br /> ❑ Bacteriological Tool(quartorl)r): <br /> ❑Nitrate Test(yearly') -_.. — — -- - — --- <br /> rM 1W??Werm 4 <br />