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SANJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup ❑ (Beans/Grounds) F-1Chocolate Covered Nonperishable Food <br /> ❑ Fried or Baked ❑ Dried Hot Chocolate ❑ Other <br /> Donuts and Waffles <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 /> Lw16 W10 V1,4 <br /> 3 Z'i cch'11 ' �-ea <br /> - rOQl�i�S C nq* nafior) OF G� G�hOe cbl ecol'* titthiE� <br /> s Uak-e L CbQ0 , Fo\J'hd , lemon a *r- chOc 1 ►-M vcl Ve <br /> C4 1 n e- upillicie AGWn I carzIme l <br /> �S C C C 1l 1 G O W 1 etqI <br /> ) <br /> TO e <br /> P-, <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />