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SAN1 a n Q U I N Environmental Health Department <br /> --COUNTY 1' <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup ❑ (Beans/Grounds) AChocolate Covered Nonperishable Food <br /> ❑ Fried or Baked Dried Hot Chocolate ❑ other_____________________________ <br /> Donuts and Waffles 7 <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 /> �r// � c�✓a1�-y �C�//'L <br /> 2 of 5 <br /> EHD 16-276/29/17 CFO REG/PERMITTING FORM <br />