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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Perm it#012345 <br /> Issued in; San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> Ingredierrts fnrichedflorr(whe�tflour,niacin,reduced irvr%thiamine,mononitrate,riboflavin <br /> and Sdic acid),bLrmr(milk,saki,d�colatechips(;agar,chocolate liquor,cocoabrnter,butterfat <br /> lmilkJ,�valnu[s,sugar,e�3,sat[,artificial vanilla aaQract,baldrg soda <br /> Contains: Wheat, milk, eggs, soy, walnuts <br /> Made in a home kitchen <br /> Net Wt. 3 oz. (85.05g) <br /> Note:For tha'Issued in County"-Identify the jurisdiction(citylcounty)where you are obtaining approval. <br /> 6. Disposals of Waste: <br /> Plea e check what type of treatment is used to dispose of waste <br /> Public Sewer Service ❑ Private Septic System <br /> I n 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 /> Na <br /> Pe e Identify the water source to be used in Cottage Food Facility(check one box) <br /> Name of Public Water System or Community Services District: COL,%�orv,k'ct W00 -c Se f'4%cg <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 lest. <br /> *(Testing frequency for transient Non-Community Water Systems after initial testing) <br /> ❑ Bacteriological Test(quarterly*): <br /> ❑ Nitrate Test(yearly*): <br /> EHD 16.27&2912023 4 CFO REGIPERMITTING FORM <br />