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SANtl J U A Q U I N Environmental Health Department <br /> -......C' (DUNTY <br /> ❑ Sweet Sorghum ❑ Roasted Coffee <br /> Syrup (Beans/Grounds) ❑ Chocolate Covered Nonperishable Food <br /> ❑ Fried or Baked <br /> Donuts and Waffles ❑ Dried Hot Chocolate E:1Other <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 oov/scripts/cdrh/cfdocs/cfCFR/CFRSearch cfm?CFRPart150 <br /> Food Descriptions: 110IR Y <br /> tlkle- `\`n <br /> Y <br /> \'(PmkwQyw(' 16- <br /> JI. 2 �r sc `i ice <br /> CWX �� is � <br /> \M � <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />