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Example: <br />Chocollate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />'ipte: For the “Issued in County" - Identify the jurisdiction (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 />lT^red®TtE Ernct’eri -ftoir IwheeflouT, naan, reduced iron, ttwarnine, mar onttrate, ntrrftewn <br />and talc acid), butler (mik, jbIt), dincotate clips Isugar, chocdateliquor, oxoabutter, butterfat <br />aelnjrs, sugar, ej^s, sth; arsfitHl vanita ertraa, tB«Tg sexto <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 />Please check what type of treatment is used to dispose of waste <br />H^ublic Sewer Service Private Septic System <br />Made in a home kitchen <br />Net Wt 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Strxkton CA 95209 <br />Perm it*D12345 <br />issued in. San Joaqu in County <br />v Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />13 Name of Public Water System or Community Services District: p , \ <br /> Private Water Supply**, Identify the source (well, spring, surface, etc.): <br />Private Water Supply. Initial Water Quality Results <br />Check boxes below rf 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*):