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SAN JOAQUIN <br />CCU NTY <br />❑ Sweet Sorghum <br />Syrup <br />❑ Fried or Baked <br />Donuts and Waffles <br />❑ Roasted Coffee <br />(Beans/Grounds) <br />❑ Dried Hot Chocolate <br />Environmental Health Department <br />❑ Chocolate Covered Nonperishable Food <br />❑ 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/efdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Food Descriptions: <br />MAtr14A It-) _ <br />(�I?G��l <br />C` Ft,00n <br />, -ron j?kwof r7cG <br />0- CAMIC IUgTcWA <br />or-Cnwlc x�Lt gY7 t`J"Aut <br />1700% 1Y"Td-' P)(C <br />6*0C A-tXA0V <br />I)IL <br />AwILL-A '15�91VAte" ('0(�►J�'T1�'f�('�? <br />+M/ <br />n /,PTHUM C-tU ►M t <br />CREAM Df- -TtR- AfZ ( <br />OA)Dt a <br />pw gLRk'AN <br />� L CUOK)tS — <br />AM T'L = <br />IZAO&U- !!�CCGS . <br />1% `(A0 .IA <br />1) PC, ANIC 91YGl4%, <br />dr?GAW)C tn`upfa0 <br />Grtf'- ,RrJlc <br />AM nr�1 t� [ <br />A c <br />olL <br />('FQVJVEre �G <br />ocf (� .IJS7�►^C�+1 <br />`,� � K ► Wj S CN✓ 9 <br />�I m lgoyit'i Sft cl <br />, <br />2 of 5 <br />EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />I <br />