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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 />6. Disposal of Waste: <br />7. Water Source: <br />n. <br />4EHD 16-27 6.29/2023 CFO REG/PERMlTTlNG FORM <br />Ingred^rts ErrKted f tour (wheat Hour, nazin. reduced iron, thiarnr>e. rrccon it rate, ribcftavm <br />andfcR acid . butter |m<h, salt , chocolatecNpa isujar, chotdateliqucr. occoabutter, butterfat <br />I'rilk . walrvts, M*. Mt»fiail.r,4i> extract. baMn| sc da <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm to 012345 <br />ssued n San Joaqu n County <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 />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 f.'Ay lod'i <br /> Private Water Supply**, Identify the source (well, spring, surface, etc.) f <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*).