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SA N yJ O A Q U I N Environmental Health Department <br /> COUNTY— <br /> El <br /> Sorghum Roasted Coffee <br /> ❑ Syrup El (Beans/Grounds) ❑ Chocolate Covered Nonperishable Food <br /> ❑ Fried or Baked ❑ Dried Hot Chocolate <br /> Donuts and Waffles ❑ Other <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 htlp://www.accessdata.fda.aov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart--150 <br /> Food Descriptions: <br /> Almond Roca, Almond Roca covered Popcorn, Rocky Road, <br /> (e6!ueA ejnd'ulyl!oal <br /> e4osSonb!I'alel000g3 <br /> druAS woa'u6ele`J'sPuowlV jallnq MOO'leen) <br /> '"BnS'je 'Am lonuspuoo <br /> es'weeap elel030g0'SPuowlV <br /> pezpnlsetlpeU <br /> peueleene 0m (ell!u 'jeans'jagng.sluelpeAul <br /> ' <br /> W nd'uIW!Ool edos'jonbiill <br /> •aleloOogO',.unq ewoo L99Z•6Z9160Z) <br /> uei ei6ul worael@lslawnseuue�auue <br /> be6ns)eleloeoyp:sl P wos'salglyepun,ceuue'MMM <br /> _ L99t6Z9160Z) LLEEZ00# <br /> worsalQljsleajlseuue®euue <br /> We'J'891QHal><e1J1,84UUa'MMM AlunoO ulnbeoP <br /> L,,Cz0o# iyuno0 DES b0ES6'VO'Aoeul <br /> umbe-r ues POE96 40"O811 peoy eslPejed L9b9L <br /> peoy ouPeied te4aL uegop>l ewoH Pe01UaO <br /> uay9i2 Mu-11 P-DIPep a ul golsuos wml epeyy <br /> e u!yOieiOS wary apepy <br /> S`9CA46�0 <br /> 606DIp5 MelROLAyeu-'r W6RL01 ry1V+Uy sy® <br /> ANNA'5 ROCK'N I�eReEe��ST-fig <br /> ROCA ROAD e06DIE51hei R6CA your WORhM <br /> Milk Chocolate <br /> Fudge dAlmo WOh Whale ANNA'S ROCA <br /> Toasted Almonds.ds,Anna s Roaa <br /> and Homemade Mmshmallows 1/2 Pound(226.79 9) <br /> Hand Dipped in Dark ChsceWly <br /> 4 ounus(1133%91 <br /> 2of5 <br /> EHD 16-27 6129117 CFO REG/PERM"ING FORM <br />