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Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Note: For the "Issued in County" - Identify the Jurisdiction (city/county) where you are obtaining approval. <br />4 CFO REG/PERMITTING FORMEHD 16-27 6^9^023 <br />Made in a home kitchen <br />Net Wt 3 oz. (85.05g) <br />6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />[JI Public Sewer Service Private Septic System <br />In the event of septic system failure or ptianbing problem, you are required to notify San Joaquin County Environmental Health <br />Department immediately. <br />l^-edteTts: ETrc'-aj-rto_r o-r, niaoa 'adjced •'zrt tr amhe. -rcr zr.ifste riac,5o«in <br />ania:»d‘. c-tte- -rik.. salt r-.o-clate s^ea'. Caccia*.e'q-xr cdice □utte'- <br />Til a> nuts suga; eggs, salt a-tiS cis Ivar ilia extract., sexing soda <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm ’ta 0122 45 <br />.ssued’n: San Joaquin County <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: CVV'A 0^ <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*):