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SA N sJ 0 A Q U IN 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 .accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 I <br /> Food Descriptions: <br /> & lie. a.m, • deh YA i i CA cA H re, <br /> 'PQp��S �G ct sa l't Colv�d� 120 cam- ?R,r q ? ees_ <br /> „Cr, bat-A T clAol I•CUf of CAv1d%e6 , Srom <br /> 0 f Ghg rmO4 vr\i x Oky\A Coa4 w I}h. +01) _ <br /> 2of5 <br /> EHD 16-276/29/17 CFO REG/PERMITTING FORM <br />