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Example: <br /> <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm it4 012345 <br />Issued in: San Joaquin County <br />Chocolate Chip Cookies with Walnuts <br />Revtegade Ravtch <br />Classic Spiced Walnuts <br />Ingredients: Walnuts, Egg Whites, <br />Sugar, Cinnamon, Salt, Vanilla <br />Extract, Cayenne <br />Net Wt 5 oz Made in a Home Kitchen <br />Clements, CA <br />Permit # MOM <br />Issued in San Joaquin Co <br />Contains: Tree Nuts, Eggs <br />Ingredients Enriched f bur (wheat flour, niacin, redixed inin, thiamine, rnononitrate, riboflavin <br />and folic acid), butter (rnik, salt), chocolatechips (sugar, chocolate liquor, cocoa butter, butterfat <br />(milk:), walnuts, sugar, eggs, salt, artificial vanilla extraa, baking soda <br />Contains: Wheat, milk, eggs, Soy, walnuts <br /> <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br /> <br />Note: For the "Issued in County"- Identify the jurisdiction (city/county) where you are obtaining approval. <br />Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />0 Public Sewer Service [6rivate 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 />Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />0 Name of Public Water System or Community Services District: <br />2/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 Non-Community Water Systems after initial testing) <br />0 Bacteriological Test (quarterly*): <br />EHD 16-27 6/29/2023 4 CFO REG/PERMITTING FORM <br />We.\ <br />.See_ cukt4L1 pd <br />OfNitrate Test (yearly*): Ste u,,W,t4d