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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 />CFO REG/PERMITTING FORM4EHD 16-27 6/29/2023 <br />In the event of septic system failure or plumbing problem, you are required to notifpan Joaquin County Environmental Health <br />Department immediately. <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />Ingredients: Enriched flour (wheatflour, niadn, reduced iron, thiamine, mononitrate, riboflavin <br />and folk acid), butter (mik, salt), chocolate chips (sugar, chocolate liquor, cocoa butter, butterfat <br />(milk), walnuts, sugar, eggs, salt, artificial van ilia extract, baking soda <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Permit# 012345 <br />Issued in: San Joaquin County <br />6. Disposal of Waste: <br />Pleasecheckwhattypeof treatment is used to dispose of waste <br />IX] Public Sewer Service U Private Septic System <br />7. Water Source: <br />Peaseldentifythewater source to be used in Cottage Food Facility (check one box) <br />S Name of Public Water System or Community Services District: California Water <br />□ Private Water Supply**, Identify the source (well, spring, surface, etc.): <br />Private Water Supply: Initial Water Quality Results <br />Check boxesbelow ifinitial water testing has beencompleted. <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*):