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Environmental Health Department <br /> -- <br /> COUNTY— <br /> El <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,jeNes 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 htt ://www.accessdata.fda. ov/scri tslcdrhlcfdocs/GfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> 06kA CWYLA 4 <br /> v <br /> IV <br /> .Ino tp �2,� <br /> MADE IN A HOME KITCHEN <br /> Permit#: <br /> Issued in county: San Joaquin <br /> Chocolate Chip Walnut Cookies <br /> Deilani Leyva <br /> 9426 Bonanza Dr <br /> Stockton,CA 95209 <br /> ingredients:Enriched flour(Bleached Wheat Flour,Niacin Iron, <br /> Thiamine Mononitrate, Riboflavin Enzymes,Folic Acid <br /> Chocolate chips(sugar,cacao beans,cocoa butter,sunflower lecithin and <br /> vanilla)Butter(Pasteurized cream,salt)Walnuts,Eggs,Sugar <br /> Contains:Wheat, Eggs,Gluten, Dairy, Nuts <br /> Net Wt. 5 oz. (141.74g) <br /> 2 of 5 <br /> EHD 16-27 6/29117 CFO REGIPERMITTING FORM <br />