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Example: <br /> BIG CAKE BAKER <br /> Stockton CA 95209 <br /> Perm it#012345 <br /> slued n- San Joaquin County <br /> Chocolate Chip Cookies with Wainuts <br /> Ingredierls:Er,richedflour lwheatflour,niacin,reduced iror,thiarrine,marcnarate,ribcflavin <br /> and#clic acld;j,truster tmilk,�It!,chDeatatQ chips Isugar,:hoc late liquor,mica butter,bitterfat <br /> lmiik;,),Walnuts,BLglar,ems,salt,artifidalvanilla ertratt,bahirg soda <br /> I..UF-li.dlilS: VUnedLf IIIIIK�e��S� }{jY+ WdillUlS <br /> I <br /> Made in a home kitchen <br /> Net Wt. 3 oz. (85.05g) <br /> Note:For the"Issued in County"-Identify the jurisdiction(city/county)where you are obtaining approval. <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 event of septic system failure or plumbing problem,you are required 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 /> dName of Public Water System or Community Services District: zllhn r� _ �L i <br /> ❑ Private Water Supply—, Identify the source (well, spring, surface, etc.): Mom, <br /> Private Warer Supply: iniriai'vvarer Quaiiry Resuirs <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 /> ❑ Bacteriological Test(quarterly*): <br /> LI Nitrate Test (yearly'): <br /> EHD 16-27 612912R23 4 CFO REGIPERMITTING FORM <br />