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SAN,-,JOAQUIN <br />=OUfJTY -- <br />- <br />Environmental Health Department <br />Example: <br />\LADE IN A ROME IUTC'BEN <br />Persil a: 12345 <br />Issued In monn': C'ou.ty vame <br />Clwmles On, ('rokill W011 W111HR. <br />Selly Bekaa <br />124 Connae Food [ane <br />.Am.W.. Cd 90ACS <br />Ingwiiivts: Buiclwd floor (Al ,st lieu. inner. rNixid ori. iluariew. <br />IIWLMitMIt. rilnMciu and folie acid 1. InmoI unk win. ciwc slate dulr <br />Irapa. clwcolate Ings. cocoa Nater. bimat\r uNal. "Ints . rugae e_ <br />xdl. atilliul sella nxunt bakiug.o,b. <br />Cv udiin: \\Les, e88e milk sey, swlouu <br />\et k1'1.5 on (85.0498) <br />Note: For Ne -issued in County'-Idanafy trrelunsdicbon (cM/counts �m you se obtaining approval. <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 of septic system failure a Plumbing problem, you are required to notify San Joaquin county Environmental Health Depart hent <br />immetlietely. <br />Water Source: <br />Pease Identity the wetersource to be used in Cottage Food Facility (check one box) <br />Name of Public Water System or Community Services District,G LO a r <br />y <br />E] Private Water Supply", Identify the source (well, spring, surface, etc.): y <br />Private Water Supply: Initial Water Quality Results <br />Check boxes below't initial water testing has been completed. <br />FN 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 (quartedy'): <br />❑ Nitrate Test (yearly'): <br />❑ Nitrite Test (every 3 years'): <br />"Addbional in/ametbn may be requlme If food b prepares loan a home wills a private water supply- check win local jurisdiction. <br />8. Food Processor Course: Initial if you agree to abide by the following: <br />J'Vi$ <br />Within 3 months of being approved to operate by the Environmental Health Department, please provide proof <br />of completion of the California Food Handler course in lieu of the California Department of Public Health (CDPH) <br />food processor course. <br />For more information see CDPH vrebsite www cdoh v aovlorovrerrlslPBaenitdbC.MaaFoa .asp <br />