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SAN1 J O A Q U I N Environmental Health Department <br /> —COUNTY— <br /> ❑ Sweet Sorghum ❑ Roasted Coffee ❑ Chocolate Covered Nonperishable Food <br /> syrup (Beans/Grounds) <br /> Fried or Baked Dried Hot Chocolate ❑ Other <br /> Donuts and Waffles ❑ <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:// w amessdata fda covlscripis/cdlO*om/efCFR/CFRSearch cfm7CFRPort=150 <br /> Food Descriptions: <br /> 1' .o/44 <br /> �✓ro c,��'v� <br /> I <br /> l <br /> I <br /> I <br /> I <br /> 2 of <br /> 610 1 6-2 7 812 911 7 CFO REGIPERMnTING FORM <br />