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Example: <br /> BIG CAKE BAKER <br /> Stcckton CA 952U9 <br /> Perm rirD123 S <br /> ssued n: San lcmu n Coun:,; <br /> Chocolate Chip Cookies with Walnuts <br /> Ingrediertt:Erricred flour(wheatflctir,rui raaLCsd IMIr,thurnine,morcritrr1r,ntcflavlr <br /> ardrtiicacid+,tt�:'arlrrilk.,rill;,chacclat4thiFslwgar,d-ccctat*IiyLcr,ccccat :Fr,[�carfY. <br /> (Milo,Ltialruts,s:..s:r,a;rc,s*1%a er;itrnalva^illa wtrat,tQjrg scga <br /> Contains:Wheat, milk,eggs,soy, walnuts <br /> Made,in a home'Kitchen <br /> Net L'Vt. 3 oz. ($5.05g <br /> Nvte:For the'Issued in County'-Identify the jurisdiction(Oy/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 or septic system failure or plumbing problem,you are required to notify San Joaquin County Environmental Health <br /> Department immedialely <br /> 7. Water Source: <br /> Pease Identify the water source to be used in Cottage Food Facility(check one box)Name of Public Water System or Community Services District: iU�V `_-XIYI )oag <br /> ❑Private Water Supply", Identify the source(well, spring,surface, etc.): 1/ <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 ara 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 alter initial testing) <br /> ❑Bacteriological Test(quarterly'): <br /> ❑!Nitrate Test(yearly'): <br /> ENO 16-27 6728l2023 4 CFO REGIPERMITTING FORM <br />