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Example: <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm t# 012345 <br />ssued in: San Joaquin County <br />Chocolate Chip Cookies with Walnuts <br />Ingredients: Enriched flour Vo heat flci, r, ciadr, reduced i roc, thiamine, monortitrate, riboflavin <br />and folic acid'i, butter Irrilk, salth chocolate chips !sugar, ocolate liquor, cocoa butter, butterfat <br />walnuts, agar, egg:, salt, 3raff 03 i variii3 extract, ta ng soda <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />Vote: 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 />"Public Sewer Service ID 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 />aName of Public Water System or Community Services District: <br />-&-tY1 T cL n <br />Private Water Supply**, Identify the source (well, spring, surface, etc.): <br /> <br />tAltA c <br /> <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 />EBacteriological Test (quarterly*): <br />LI Nitrate Test (yearly*). <br />END 16-27 6/29/2023 4 CFO REG/PERMITTING FORM