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SAN-.,,,'O n QU I N Environmental Health Department <br /> —.COU 1`J TY <br /> Sweet Sorghum Roasted Coffee <br /> Syrup (Beans/Grounds) F-1Chocolate Covered Nonperishable Food <br /> Fried or Baked <br /> El Donuts and Waffles ❑ Dried 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: <br /> lemc?r% c(Qu-J5 (ccoLe,,) Gia chocolat{ 4„n (ooL"-'e" <br /> gLi-e11 A-e-e Lkl( dour <br /> b ak,rzgov"der ba �� socket <br /> saL S'z(f <br /> — <br /> bL"#e4 6.4ww <br /> 51,t_g 5 t ty— <br /> (Cmo v% 2e 5f "'t(,-,E Va yJ lla 42x`�a(t <br /> ears II / ff I" J /r <br /> SerruSweei /wh.�P 0(0[4LJe- <br /> �e�r,w� bLA" 61,os5dm s <br /> k-5,;es r-k- o L X+---s <br /> eea4l J 6 r <br /> �q�� �'rDwr 5u�t� e-ggs �uwe�er �cuv� <br /> Vava(Q exlm f So-It �a�t:v�4, �v�J.4 <br /> Uows bcLL . coal-Ps, va V1;Lia 5c1*1+ <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />