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1 Water Source; <br />to be used in Cottage Food Facility (check one box) Pease Identify the water source <br />Name of Public Water System or Community Services District: <br />Private Water Supply —, Identify the source (well, spring, surface, etc.): <br />\kid\ <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 & results in space <br />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 />Nitrite Test (every 3 years"): <br />Additional information may be required if food is prepared from a home with a private water supply — check with local jurisdiction. <br />1 Food Processor Course:Initial if you agree to abide by the following: <br />Within 3 months of being approved to operate by the Environmental Health Department, please provide proof of <br />completion of the California Food Handler course in lieu of the California Department of Public Health (CDPH) food <br />processor course.