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Example. <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Perm it#01234S <br /> ]sued n San Joaqu n Count-, <br /> Chocolate Chip Cookies With Walnuts <br /> Ingredients:Enriched flour 1voheat flour,niacin,reduced iron,thiamine,mononitrate,ribcfla"in <br /> and folic acidi,butter Imilk,salt;-,chocolate chips(sugar,dhocdateliquor, myna butter,t€nerfat <br /> tmilk1,walnuts,sugar,e;gs,sa]t:artificialvanilla extract,baiting soda <br /> Contains: Wheat, milk, eggs, soy, walnuts <br /> Made in a home kitchen <br /> Net Wt. 3 oz. (85.059) <br /> Note:For the"Issued in County"-Identity the jurisdiction(city/county) where you are obtaining approval. <br /> 6. Disposal of Waste: <br /> PI ase 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 /> V] Name of Public Water System or Community Services District: C <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 Ston-Community Water Systems after initial testing) <br /> ❑ Bacteriological Test(quarterly*): <br /> ❑ Nitrate Test(yearly"): <br /> EHN 16-27 6/29/2023 4 CFO REGIPERMITTING FORM <br />