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Ater Source- <br /> Pease Identify the wafer source to be usod in College Food Facility(check one box) <br /> I <br /> Name of Public Water System or Community Services DisiricC <br /> Private Water Supply",Identify the source(well,sprang,surface,etc.): <br /> i <br /> �Aj <br /> Private Wafer Supply.Initial Water Quality Results <br /> Check boxes below if initial water testing has been compleled. <br /> lI le-sting must he done at a State Certified Laboratory Either attach lob resulls or provide name of fain,date&results in space <br /> provided next to type of lest. <br /> [Testing frequency for transient Non-Community Water Systems after initial testing) <br /> Bacteriological Test(quarterly'): <br /> Nitrate Test(yearly'): <br /> Nitrite Test(every 3 years"): <br /> -Adlfti—l'^r°n bo^may Ce required 0 food a prepared from a home with a prWle waler Supply-Check with local judsdlclion. <br /> 1. Food Processor Courseanitial if you agree to abide by the following: 'A <br /> l <br /> Within 3 months of being approved to operate by the Environmental Health Deparlmenl,please provide proof of <br /> completion of the California Food Handler course in lieu of the California Department or Public Health(CDPH)food <br /> processor course. <br />