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Exyinplo: <br />Chocolate Chip Cookies with Walnuts <br />CoxUains: Wheat, o'b.lk, Cggs.> &>v* ^Inuts <br />Note: Foj Hh> ‘iwurtxi if) eotmty-’ liteility Hw jiirtMk'k'n w1k>u> yt'ii xnv Mnuni) n^wal <br />/ Wnloi Sy&joma i <br />mcL <br />4EHO 16076/^4*033 III OniWIHMIfllWiKHIM <br />t wktNk (RtUnd fLM Iwfeftat tkio. Wn.on (attarcdlx»J\ OfcilMn <br />*s t<'> Mtot (niK toll], thtKt'bot Ntu |a<»,i<ux’tf«ulcju.Ml gjjjj#butte hoHMtffl <br />[n>dK>: W«Jn.t4 e«w:, WMi Bti'wUlvwf’SU fe*r«fl tetMtU «HU <br />Macle hi a home kitchen <br />Net Wt 3 or. (85.05g) <br />BIG CAKE BAKER <br />mklon CA <br />PtnnlUOUJW) <br />1 in Son k»aQut cunt v <br />7. Wator Sourco: <br />Pt/ase Identity the water source to bo used in Cottnije Food Facility (check ono hex) <br /> Name of Public Water System or Community Services District: <br />[^Private Water Supply**, Identify the source (well, spring, surface, el/): j <br />Private Water Supply: Initial Wator Quality Results x. <br />Check boxes below if Initial water testing hnn been cornplelod ------- <br />All testing must bo dono al n State Certifted l.aborntery. Either attach lab results or provldo name of Inh, date & <br />results in spneo provided next to typo of lest <br />’(Testing frequency for transient Non-Communlty Water Systeniiktilloi Initial teBtlng) <br /> Bacteriological Test (quarterly*): <br /> Nitrate Test (yearly4): <br />6. Disposal of Waste: <br />Please check w/iat t^pe ofti&etnwiU is used lo dispose of waste <br /> Public Sewer Service [^Private Septic System <br />In IIk> event o! septic Dystom fuikiru oi plumbing problem, you om required to notify Ban Joaquin County Environmental Health <br />Department enntediately