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   CCDEH Model CFO Registration/Permitting Form (Updated 12‐21‐2012)                                     Page 4 of 5  <br />  <br />6. Water Source: <br />Please identify the water source to be used in Cottage Food Facility (Check one box) <br /> <br /> Name of Public Water System or Community Services District: <br /> If you use a 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. <br />Then either attach lab results or provide name of lab, date & results in space provided next to type of test. <br />* (Testing Frequencies for Transient Non-Community Water Systems after initial testing) <br /> Bacteriological Test (quarterly*): <br /> Nitrate Test (yearly*): <br /> Nitrite (every 3 years*): <br />**Additional information may be required if food is prepared from a home with a private water supply – Check with local jurisdiction <br /> <br />7. Disposal of Waste: <br />Please check what type of treatment is used to dispose of waste <br /> <br /> Public Sewer Service Private Septic System <br /> <br />٠ In the event of septic system failure or plumbing problem, you are required to notify <br />Alameda County Department of Environmental Health immediately. <br /> <br />8. Food Processor Course: Initial if you agree to abide by the following: ________ <br /> <br />Within 3 months of being approved to operate by the Environmental Protection Division, <br />please provide proof of completion of the required California Department of Public Health <br />(CDPH) food processor course*. <br />Proof of completion may be faxed to our Department at 510-337-9432. <br />* See CDPH Website for more information: http://www.cdph.ca.gov/programs/Pages/fdbCottageFood.aspx <br /> <br />9. Employee: Initial if you agree to abide by the following: ________ <br /> <br />I understand that I may not have more than one full-time equivalent cottage food employee, <br />not including a family member or household member of the cottage food operator, working <br />within the registered or permitted area of a private home where the cottage food operator <br />resides and where cottage food products are prepared or packaged for direct, indirect, or <br />direct and indirect sale to consumers. <br /> <br /> <br /> <br />