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.2-Feb-2018 12:42 From Abigail Albarillo. Phone 115105868868 FaxZero.com p.6 <br /> Example: <br /> Permit': 112 45 <br /> isiueti is cuuah--Cnunt'mime <br /> < o a,;;c( lli C•rl:ies 1 itlt i lad[ <br /> -.r � jag,lx.f i.es <br /> ,11 ll1 Le:.A- <br /> 9(XV <br /> 'gY#p-mlcuk5. lmi6ed Ru141'4404Iloi a'iuv_m 2��ivcu n <br /> ,'ikl�Jiuti'ix,rifi�H�[uiulki tlibl;nu2tt hii' r++x}i t�`\iii)e1x�i Izr 4kgi- <br /> {lTapr Thtwti�lil2 hgt4ii cMCitlifarrttl tyauefiai l }�iV$SUOti xux'rt e'_�L <br /> satr�niiiunn[•r.;tmilarirnr.r..:E�nkaugtLKLti '-. s.: <br /> ,(b§tatirs:t�heat xyrat114aa+ wataLts <br /> yef}*ry 3 pk.ttK fIOkl <br /> F L <br /> !Jute:For the-1sadedin County--Idea*the jurisdiction(cityearrnty)where you are obtaOOg approval <br /> 6. Disposal of'Waste:. <br /> Please check what type of treatment is used to dispose of waste <br /> N Public Sewer Service ❑ Private Septic System <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 /> 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. Gil of t atrlrT <br /> Fj Private Water Supply*", Identify the source(well,spring, surface:etc.): <br /> Private Water Supply:Inklaf Water Quality Results T <br /> Check boxes below if Initial water testing has been completed. <br /> All testing must be done at a State Cattifed Laboratory. Either attach lab results or provide name of lab,date& <br /> results in space provided next to type of test. <br /> I(Testing frequencyfor transient Non-Cammunity Water Systems after initial lasting) <br /> Bacteriological Test(quarterly): <br /> El Nitrate Test(yearly'): <br /> ------------- <br /> [] Nitrite Test(every 3 years'): <br /> —Additional Information may be required If food is prepared from a home with a private water supply—.check with local jurladlction. <br /> 6. Food Processor Course: Initial if you ague fo abide by the following: <br /> Within 3 months of being approved to operate by the Environmental Health Department,please <br /> provide proof of completion of the California Food Handler course in lieu of the California.Department <br /> of Public Health(CDPH)food processor course. <br /> For.more information see GDPH website www.cduh.ra.aovloronramslPaaasMdhCottageFood.aso <br /> EHD 1&272(3117 4 CFO REGIPERMirnNG-FORM <br /> Received Time Feb, 1, 2018 8: 34PM No. 2980 <br />