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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 junsdtchon (city/county) where you are obtaining approval <br />4EHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <br />InjrBdWntt Enrktiw) ttoi» |wh <w Hour, niacin, radix od Iron, thramina. mononit an a, riboflavin <br />•nd folk Kid), buttar |mtk. nit), choc elate chi pi I infer, chocolate liquor, cocoa butter, butterfat <br />|mili}. walnuts, agar, eggi, sale, artificial vanilla ertract, baling soda <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm it« 012345 <br />Issuedin San Joaqum County <br />6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />Public Sewer Service Private Septic System <br />In the event ol septic system failure or plumbing problem, you are required to notify San Joaquin County Environmental Health <br />Department immediately. <br />7. Water Source: <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: <br />O Private Water Supply**, Identify the source (well, spring, surface, etc.): d <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*):