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SA N vJ O A Q U I N Envirt ental Health Department <br /> COUNTY— <br /> El Sorghum Roasted Coffee <br /> Syrup E] (Beans/Grounds) Chocolate Covered Nonperishable Food <br /> Fried or Baked <br /> ❑ Donuts and Waffles ElDried Hot Chocolate ❑ Other <br /> * Do not contain eggs,cream, or cream cheese <br /> "If preparing jams,jellies or fruit butters, include a list of ingredients(attach separate page if needed). These items <br /> must comply with standards described in Part 150 of Title 21 of the Code of Federal <br /> Regulations http://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch cfm?CFRPart=150 <br /> Food Descriptions: ' S are- D� <br /> aln0 ` � as C <br /> macho 69-cip25 <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />