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Example: <br />BIG CAKE BAKER <br />Choco late Chip Cookies with Wa lnuts <br />Comaosr. Wheat «w»illk, eggs., soy, wataurts <br />Note; For the “Issued in County" - Identify the jurisdiction (city/county) where you are obtaining approval. <br />6. Disposal of Waste: <br />7. Water Source: <br />CFO REG/PERMITTING FORM4EHD 16-27 6/29/2023 <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 />iMlade m a home tetcheni <br />Net Wt 3 oz. (85.05g)) <br />Please check what type of treatment is used to dispose of waste <br />0 Public Sewer Service Private Septic System <br />Imerafierts Ermchat flour iwfr.aKi.owr.,-nanir. reduce® itof. charnire. ’-cr orir.rare. ntols-irr <br />araifd*c abtf j. burner IirMk,. sair.i, chcrdzrechcpE :tsu§ar. tJ-<ncda:el»q>uDr. tomstuxr.a. bumerfa: <br />IfflTiBtfi, sugar.. frgES. sft^ antS'dal vanita acres: tH-K-ne sols <br />Stocktcrr CA 952.09 <br />Peirrt* 012345 <br />Isswed rm: Sai- ifoaqsx ft Couanfty <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />0 Name of Public Water System or Community Services District. c;a /Huh .f,i px( IjVj [\ <br />□ Private Water Supply**, Identify the source (well, spring, surface, etc7)- ' * / I— j <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*):