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Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Note: For the "Issued in County" - Identify the junsdiction (city/county) where you are obtaining approval <br />6. Disposal of Waste: <br />7. Water Source: <br />4 CFO REG/PERMITTING FORMEHD 16-27 6/29/2023 <br />Ingrediens: Enriched flour (wheat flour, riacin, reduced iron, thiamine, mon on it rate, riboflavin <br />and folic acid), butter (milk, salt?, chocolate chips Isugar, chocolate liquor, cocoa butter, butterfat <br />(mBk). walnuts, sugar, eggs, salt, artificial vanflla extract, bating soda <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 />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />Please check what type of treatment is used to dispose of waste <br />0 Public Sewer Service Private Septic System <br />BIG CAKE BAKER <br />Stockton CA 952C9 <br />Permit# 012345 <br />issued n San Joaquin County <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />0 Name of Public Water System or Community Services District: Qty of Stockton <br /> 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 /> Bacteriological Test (quarterly*): <br /> Nitrate Test (yearly*):