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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 />4 CFO REG/PERMII UNG FORM <br /> <br />EHD 16 27 6/2G/2023 <br />Ingredients: Enntfred flour (wheat flour, niacin, reduced Iran, thiamine, mononitrate, riboflavin <br />and folic acid), butter (milk, salt), chocolate chip (sugar, chocolate liquor, cocoa butter, butterfat <br />Imilk), walnuts, sugar, eggs, salt, artificial van ilia extract, baking soda <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 />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br /> <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm <t# 012345 <br />issued in- San Joaquin County <br />I <br />■ <br />6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />0 Public Sewer Service Private Septic System <br />7. Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />[J Name of Public Water System or Community Services District Clty of Tracy <br /> Private Water Supply**. Identify the source (well, spring, surface, etc ). <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 Waler Systems after initial testing) <br /> Bacteriological Test (quarterly*) <br /> Nitrate Test (yearly*)