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p.62056934145Uarsha Nandani Raj8-riay-Z0Z5 13:41 <br />Example: <br />Chocolate Chip Cookies with Walnuts <br />•i <br />• Contains: Wheat, milk, eggs, sc?y, walnuts <br />A'p»e i^or the Vssuad in County’ - Identify the juristficbari (city/cMrrty) where you are obtaining approval <br />7e Water Source: <br />4 C=D REGff’HRMrmNG FORMEl-iD 16-2 7 6/29/2023 <br />I <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g} <br />In tiie event uTseptic system failyr® or plumbing probtetn, you an? required to notify San Joaquin County Environmental Hcaitb <br />Oe pa rtment immediately. <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm 012345 <br />issued in: San loequ5n County <br />6. Disposal of Waste: <br />Please check what type at treatment is used to dispose of waste <br />S Public Sewer Service EJ Private Septic System <br />■ Ergrssitenis. Enr khsri fkxX flour, ol»dr$ redtxod: Km, thtamirre, ojuncntas;^ rfcc^iin <br />; snd f€& scWj, bttrer {milk, thsccfer*chics, {argar, cftcctS'et-efiqucw, ascoa butter, butterfat i <br />i (cntt&waJriutE, swgat, -3^5> =31^ anffidalvanifla tehng scda <br />Pease Identify the waler source to be used in Cottage Food Facility (check one boy) <br />EZI Name of Public Water System or Community Services District: Qj|y of <br />|_1 Private Water Supply**, Identify the source (weH, spring, surface, etc ): <br />Private Water Supply: Initial Wafer Quality Results <br />Check boxes below if initial water testing has been comoleted. <br />All testing must be done at a State Certified Laboratory. Either attach lab results or provide name of fab, date & <br />results in space provided next to type of test <br />’(TOsting frequency for transient Non-Community Water Systems after initial testing) <br />O Bacteriological Test (quarterly*); <br />□ Nitrate Test (yearly*):