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SANJ O A Q U I N Environmental Health Department <br />COUNTY— <br />Sweet Sorghum Roasted Coffee <br />❑ Syrup ❑ (Beans/Grounds) ElChocolate Covered Nonperishable Food <br />Fried or Baked <br />E] Donuts and Waffles ElDried Hot Chocolate F-1Other <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.gov/scripts/cdrh/cfdocs/cfCFRICFRSearch.cfm?CFRPart=150 <br />Food Descriptions: 00,e IN1 X_ k f 4' <br />a <br />2 of <br />EHD 16-276129/17 CFO REG/PERMITTING FORM <br />