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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 (city/county) where you are obtaining approval. <br />7. Water Source: <br />EHD 16-27 6/29/2023 4 CFO REG/PERMITTING FORM <br />I <br />j <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 />Made m a home kitchen <br />Net Wt 3 oz. (85.05g) <br />Ineredierts: Enriched flcur hvhst flour, niadn. reduced iron, th ran-ire, m era’it rate, ritonavir <br />and fclic acid?, butter Imik. salt-, chocolate chips (sugar, chocolate liqtcr. rocca butter, butterfat <br />Imilkf, walnuts, sugar, eggs, salt anffi da I vanilla extract bating soda <br />BIG CAKE BAKER <br />Stockton CA 952C9 <br />Perm tS 012345 <br />ssued n: San .loaou'-n 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 />Pease Identify the water source to be used in Cottage Food Facility (check one box) <br />Name of Public Water System or Community Services District: Qj <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 />-esuus in space 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*)