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SAN10 A Q U I N Environmental Health Department <br /> COUNTY <br /> Sweet Sorghum Roasted Coffee <br /> F] Syrup ❑ (Beans/Grounds) ElChocolate Covered Nonperishable Food <br /> Fried or Baked <br /> El Donuts and Waffles ❑ Dried Hot Chocolate F] 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: I- � <br /> Mac — Vi lffl, bLt 14aLCV-(GVY) lfs r? <br /> 1I - <br /> �am f Jel �l ltn rub� s <br /> G <br /> G - US ea s b vz SIA ✓c Imre c� <br /> I• -- s s - v ' 2v <br /> -f?,t4-TreTat- <br /> �cth�al p�i�i�l <br /> C - rn m iw<-f� --�I l-c <br /> 1� 5 ' r7tic G CIVVY1 W� <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />