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SA N D10 A Q U f 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:/N✓ww.accessdata.fda.gov/scripts/odrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> N -mai is ove V4 a h am Mem wi <br /> 44 om gvkjo A Ae. <br /> 1 1, <br /> ` k <br /> 1 <br /> 4a!�ofAc , rhe_rr.A@ k_AC b--40. <br /> 2of5 <br /> EHD 16-27 6/29/17 CFO REGIPERMIT7ING FORM <br />