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SA N pJ O A Q U I N Environmental Health Department <br /> COUNTY ---- <br /> Sweet Sorghum Roasted Coffee <br /> E] Syrup ❑ (Beans/Grounds) ❑ Chocolate Covered Nonperishable Food <br /> ❑ Fried or Baked <br /> Donuts and Waffles ❑ Dried Hot Chocolate ❑ Other <br /> i <br /> Do not contain eggs,cream,or cream cheese <br /> "If preparing Jams,jellies or fruit butters,include a Itst 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 i <br /> Regulations htttvlMrxw ecoes..dala fda eo IscriotslcdmlcfddcsldCFRICFRSOarch'dm7CFRPad=150 <br /> • ! r <br /> Food Descriptions: <br /> `aR r.�aS <br /> I e WQ <br /> ' I <br /> 2of5 <br /> ERD 16.27629117 CFO REGIPERMnTMG FORM <br />