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SA N dJ O A Q U I N Environmental Health Department <br /> —COUNTY— <br /> Sweet Sorghum o Roasted Coffee ❑ Chocolate Covered Nonperishable Food <br /> Syrup (Beans/Grounds) <br /> Fried or Baked <br /> El Donuts and Waffles LlDried Hot Chocolate ❑ 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 http://www.accessdata.fda.cov/scripts/cdrh/cfdocs/efCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> 6A K'�O CZ'O kA S - Vf,TAt`l— tib BGG S i C_R-�Nq t au-co5w6_g'i <br /> �. JPiWVV BVAA5z C440GO 1ATT- C441 - (SU N CNoco�ar� CNiYS- <br /> NO ` <br /> Z ril��t �aT`L �'.F4;P CoUit~1�L5 tV¢/-AN (2,HoGyLAi- : CHIPS- <br /> Nn tMI(,tc ) PPIR1 , 02 z6� ) <br /> 2 of <br /> EHD 16-27 6/29/17 CFO REGIPERMRTING FORM <br />