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Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />■Vofe For the ‘Issued in County' - Identify the jurisdiction (city/county) v/here you are obtaining approval <br />AEHD 16-27 6'29^023 CFO REG/PERMITTING FORM <br />I <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 m a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm Att 012345 <br />Issued in San Joaquin County <br />I <br />i <br />I6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />IX Public Sewer Service Private Septic System <br />Ingredients Ennched flour (wheat flour, maor\ reduced iron, tbra'-’ire. rrorcrcraze, ribcflaan <br />andfdic add), butter |mik. salt), chocolate chps Isugar. choccfate liquor, cocoa butter, butterfat <br />Imilk). walnuts, sugar, eggs, sit artificial van fl la extract, teiirg soda <br />7. Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />XI Name of Public Water System or Community Services District: <br /> Private Water Supply**, Identify the source (well, spring, surface, etc ): z <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 alter initial testing) <br /> Bacteriological Test (quarterly*) <br /> Nitrate Test (yearly’)