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SA N J O A Q U IN Environmental Health Department <br /> COUNTY <br /> ❑ Sweet Sorghum ❑ Roasted Coffee Chocolate Covered Nonperishable Food <br /> Syrup (Beans/Grounds) <br /> Fried or Baked <br /> ❑ Donuts and Waffles Dried Hot Chocolate ❑ 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/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> Chocolate spheres filled with marshmallows for hot chocolate beverage. <br /> Ingredients: sugar, palm and palm kernel oil, cocoa, nonfat dry milk. <br /> sorbitan tristearate, soy lecithin, salt. <br /> Corn syrup, sugar, dextrose, water, gelatin, tetrasodium pyrophosphate <br /> 2 of 5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />