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SA K J O A Q U I N Environmental Health Department <br /> —COUNTY <br /> ❑ Sweet Sorghum ❑ Roasted Coffee ❑ Chocolate Covered Nonperishable Food <br /> Syrup (Beans/Grounds) <br /> m 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 htto://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> i — �_ <br /> Food Descriptions: CU? CAKE 5-H00T(5RS , GHARCUTCRIE <br /> 60,AR9S , CEV)CHE , COW f3A&Sv CA " 0 � POAIUTS , LF1v2RoS <br /> 1�DPt:.or2ni <br /> t" V� V1Cho.(cvc�e r 2 bow- c9-Z <br /> we <br /> 2orf s <br /> EHD 16-27 6/29117 CFO REG/PERMn nNG FORM <br />