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Sn N JO n Q � I I N Environmental Health Department <br /> ri <br /> COUNTY— <br /> E] <br /> OU NMTYV-1, <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup El (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:Nwww.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> ba�ea Cnokie5 - bist,o�!-i � Chou�lal-e HiQ , S�ni�l�rdd l� <br /> �urno1G1✓1 <br /> Q"u a, <br /> Ku - , Irl �berru <br /> I UMID ' bar f ayw _noLy <br /> V <br /> Z Va'Vl u- A b►r� <br /> 2 of <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />