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Made with Xodo PDF Reader and Editor <br />Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Note: For the "Issued in County" - Identify the junsdiction (city/county) where you are obtaining approval <br />4 CFO REG/PFKNITTING FORMEHO 16-Z7W2W2023 <br />1%'edtentJ Enrfched flour (wheat flour, niadn, reduced iron, thiamine, mcrooitrate. riboflavin <br />end foik acid), butter (milk, salti. chocolate chips (sugar, chocolate liquor, cocoabutter, butterfat <br />walnuts, sup ar, eggs, salt, artifidalvanilla extract, baking soda <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm it* 012345 <br />Issued m San Joaquin County <br />6- Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />"^Public Sewer Service 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: I % V j 11 <br /> Private Water Supply”, Identify the source (well, spring, surface, etc.): O '" <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*):