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Example: <br />! <br />I <br />plumbing problem, you are required to notify San <br />CFO REG/PERMITT1NG FORM <br />4 <br />EHD 16-27 6/29/2023 <br />i <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />| <br />1 <br />big cake baker <br />Stockton CA 95209 <br />Perm it# 012345 <br />Issued in: San Joaquin County <br />>u aro obtaining approval. <br />Chocolate Chip Cookies with Walnuts <br />..............—w- <br />Contains: Wheat, milk, eggs, soy, walnuts <br />6 Disposal of Waste; <br />™ S.B,O s„„ <br />r Ub" ’ Sen,|e' _____ ___________________ 3an JoMu«»* <br />In the event of septic system failure or <br />Department immediately. <br />Nole: For llK -issued in County - identify iudsdiodon (city/oounty) where yo< <br />7 SJZS-erS0Urce to bS „ P00d «one b0X) <br />M Name of Public Water System or Community Services District. —MW <br />□ Private Water Supply”, Identify the source (well, spring, surface, e c.): -------------------------------------- <br />auach fat, resuits or proviUe name of iah, date & <br />KnTyt"nt ^-Community Water Systems after initiaf testing) <br />□ Bacteriological Test (quarterly ). ------- ------- ---------------- -————— <br />□ Nitrate Test (yearly*): --------------- ------ ------------------