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Example: <br />Chocolate Chip Cookies with Walnuts <br />Contains: Wheat, milk, eggs, soy, walnuts <br />Note For the "Issued in County’ ■ Identify the jurisdiction (cily/county) where you are obtaining approval <br />CPORLG/PLRMn I ING FORM4LHO 16-2 7 6/29/2023 <br />Made in a home kitchen <br />Net Wt. 3 oz. (85.05g) <br />Ingr edicts EncKJ-eS f tevr (xvher flcvr, roan, red teed iron, thiamint, mon co it rate, rlbofladn <br />and fol«: Kdj, better Imlk. »lt,', <toc elate chips |se(ar, choc cl ate liquor, cccoabutter, butt eHit <br />walrvti. sugar eggs. salt, artificial vanilla extract, baMng soda <br />BIG CAKE BAKER <br />Stockton CA 95209 <br />Perm it« 012345 <br />issued San Joaquin County <br />6. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br />$ Public Sewer Service Private Septic System <br />In the evert ol septic system failixe or plumbing problem, you are reqtired to notify San Joaquin County Environmental Health <br />Department immediately <br />7. Water Source: <br />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />g Name of Public Water System or Community Services District: /I , U. <br /> 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 />•Cresting frequency for transient Non-Community Water Systems after initial testing) <br /> Bacteriological Test (quarterly*): <br /> Nitrate Test (yearly*):