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Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />EHD 16-27 6/29/2023 4 CFO REG/PERMITTING FORM <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Permit# 012345 <br />Issued in: San Joaquin County <br />Note: For the "Issued In County" - Identify the jurisdiction (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 />'0 Public Sewer Service Q private Septic System <br />Depart^erndn^med?atelytem plUmbing problem' you are required to noti* San Joat»uln CoiW Environmental Health <br />7. Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />'S. Name of Public Water System or Community Services District: . <br />□ Private Water Supply**, Identify the source (well, spring, surface, etc.): T ~ <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 />Ingredients: Enriched flour (wheatflajr, niacin, reduced i run, thiamine, mcrcnitrate, riboflavin <br />and fclic acid), butter (milk, salt), chocolate chips (sugar, chocolate liquor, cocoa butter, butterf=* <br />(milki. walnuts, sugar, eggs, salt, artificial vanilla extract, baking soda