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SANJOAQU IN Environmental Health Department <br /> _COUNTY____ <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup ❑ (Beans/Grounds) Chocolate Covered Nonperishable Food <br /> Fried or Baked <br /> ❑ Donuts and Waffles ❑ Dried Hot Chocolate F1Other <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 Desc iiatiiriis: <br /> Qi/ -? . <br /> r j 7� <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />