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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Permit#012345 <br /> Issued in: San Joaquin County <br /> Chocolate Chip Cookies with Walnuts <br /> Ingredients Enriched flour(whsatflour,niadn,reduced iron,thiamirne,mananitrate,riboflavin <br /> and folic acid),butter(rrrlk,salt),dnacolatechips(sugar,dbwdateliquor,mtos butter,butterfat <br /> (mill,walnuts,sugar,eggs,salt artificialvanilla sacrad,baiting soda <br /> Contains: Wheat, milk,eggs, soy, walnuts <br /> Made in a home kitchen <br /> Net Wt. 3 oz. (85.058) <br /> Note:For the'Issued in County"-Identify the jurisdiction(city/county) where you are 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 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: (om/ a) C�a 4_�Y <br /> 7",A19 <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 Water Systems after initial testing) <br /> ❑ Bacteriological Test (quarterly*): <br /> ❑ Nitrate Test (yearly*): <br /> EHD 16-27 6129/2023 4 CFO REG/PERMITTING FORM <br />