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Example. <br /> BIG CAKE BAKER•, <br /> Stockton CA 95209 <br /> Permit#012345• - <br /> issued in San loequln County ki <br /> Chocolate Chip Cookies with Walnuts �P <br /> l t?$, 407 t'L6 Ivs� reduced' ,thiamine.monanitretR riboflavin <br /> Ingredients:Enr'khAflcir(wheat flour,III . �rtrn Cutterfat <br /> and fd-c acid butter), UTM Ok.5aIC)•chocolate Chips I subs:b-Wa>anCd'te l iq uor,co,*butter, <br /> (milk},walnuts,Agar,eU.1 salt,arnfioalvari4W extraR, E soda <br /> ontains: Wheat, milk,eggs, soy, walnuts <br /> Made in a home kitchen <br /> Net Wt. 3 oz. (85.059) t <br /> ote,For the-Issued in County"-Identify the iwisdiction(city/county)where you are obtaining approval. <br /> 6. Disposal of Waste; <br /> Please check what type of treatment is used to dispose of waste <br /> ❑ Public Sewer SerVice 129 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 /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box) <br /> ❑ Name of Public Water System or Community Services District: <br /> ig Private Water Supply—, Identify the source (well,spring, surface,etc.): W <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*): <br /> EHD 16-27 6r29/2023 4 CFO REGIPERMITTING FORM <br />