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SA kJ O A Q U I N Environmental Health Department <br /> COUNTY <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup ❑ (Beans/Grounds) ElChocolate Covered Nonperishable Food <br /> Fried or Baked <br /> Donuts and Waffles L1Dried 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 Descriptions: rr <br /> J Q�'Y�S ��► e S �f1�P h � V S�a W�rrvl. 'D� �n_ y��(�;- - <br /> a ber J. ,rte n <br /> a - SII <br /> Ll <br /> �� <br /> cam66 soup mive6 drA a Dkn <br /> Lr p- <br /> C,A_ �S n�,�Imo. ►-� n _�,e�n o�n Ut,�e rn� ca��• <br /> T <br /> 2 of 5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />