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1. Water Source: <br /> -ease Identity the water source to be used in Cottage Food Facility(check one box) <br /> Name of Public Water System or Community Services District: <br /> Private Water Supply",Identify the source(well,spring,surface,etc.): <br /> �Aj <br /> Private Water Supply.Initial Water Quality Results <br /> heck boxes below if initial water testing has been completed. <br /> II testing must be done at a Stale Certified Laboratory. Either attach lab results or provide name of lab,dale&results in space <br /> rovided 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 vrith a private water supply—check wilh local Jurisdiction. <br /> 1. Food Processor Course:lnitial 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. <br />