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Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Note For tlte 'Issued in County" - Identify the jurisdiction (city/county) where you are obtaining approval <br />7. Water Source: <br />EHD 16-27 6/29/2023 4 CFO REG/PtHMIl IINGFORM <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Pe on it« 012 345 <br />Issued in San Joaquin County <br />6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />H Public Sewer Service Private Septic System <br />•npredterKs Enrrhed f tow (whcM flour, ri>dn, reduced iron, thiamine, mononitrate, riboflavin <br />and folic acid). biXttr |mik, salt), chocolatechips |sujar, chocolate liquor, oocoa butter, butterfat <br />(mik), wainutx sc«ar. salt, artificial van I to wtract, baMr^ 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 />Pease Identify the water source to be used in Cottage Food Facility (check one box) , <br />EfName of Public Water System or Community Services District: Lqjvc Oisfrl / <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*):