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Example: <br />Chocolate Chip Cookies with Walnuts <br />4EHD 16-27 8/2872023 CFO REQ/PERMITTING FORM <br />I <br />Made in a home kitchen <br />Net Wt 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Permit* 012345 <br />Issued in: San Joaquto County <br />7. Water Source <br />Pease Identity the water sourve to be used in Cottage Food Facility (check one box) <br />0Name of Public Water System or Community Services District <br /> Private Water Supply**, Identify the source (well, sprino, surface, etc.): <br />Private Water Supply. Initial Water Quality Results <br />Check boxes below if Initial water testing has been completed. <br />A8 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*): <br />For tn. issued in County - Identity the jurisdiction (aty/oounty) where you ere obtaining approval. <br />6. Disposal of Wastf: <br />Please check what type of treatment Is used to dispose of waste <br />^Cblfc Sewer Service Private Septic System <br />In the went of aapHo eysiam faBute or plumbing problem, you are required to notify Ban Joaquin County Environmarrtal HaaKh <br />Depertnwfit jmnwdiatBly. <br />fto»r (•♦».« flour, Iron thbmf*. monontawa, rttofl-Un <br />r^fdc acai tH«r -h), mototeacNp l^pr. mad., tea*, co®, bueert* <br />Imtti. •atnns, *«Br. MP. arahaaIonita aeratt, baMr< rodi <br />Contains: Wheat, milk, eggs, soy, walnuts