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SA N 10 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 /> El Donuts and Waffles ❑ Dried Hot Chocolate E] 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.00v/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: Ea4j COOc, - ' IJ& Cookies :j Ty-owy\nties <br /> 2 of 5 <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />