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SANJ O A Q U I N Environmental Health Department <br /> COUNTY - <br /> Sweet Sorghum Roasted Coffee <br /> ❑ Syrup El (Beans/Grounds) ❑ Chocolate Covered Nonperishable Food <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 /> Hca ' � �. ►� 6Ic <br /> RY. Matte <br /> ePEpD5 tl. MOq <br /> MADS IN A t--IOM KITC-IC—N 3 — <br /> PEUMII#:0A ISSUED IN SAN]GAVIN CHH CINNAMON 4MN <br /> ING&EDHU' RYE[[OUR,SPELT HOUR,WRIER,WHOSE WHEAI[LOUR,RAISINS,PYURE e Spot,sourd0 J - <br /> (ERYiHRI L STEVIA EEAf WWI(REB A),NATURAL EEAVOR),EINNAMON,SAIi ____01 I <br /> Brenda Shofer ti09-b�9—Stili bdshoferig(a�mail.com IG kneadsProof <br /> i35 S Church A Lod(, 6A %M0 <br /> 2 of <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />