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-SAN J O A Q U I N Environmental Health Department <br /> , —COUNTY <br /> El Sweet Sorghum Roasted Coffee <br /> Syrup El (Beans/Grounds) El Roasted Covered Nonperishable Food <br /> Fried or Baked <br /> El Donuts and Waffles ElDried Hot Chocolate ElOther <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 htti)://www.accessdata.fda.gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: Cookies <br /> MADE IN A <br /> HOME KITCHEN <br /> Pe1mi1 N:PT6627644 <br /> I"uW in county:San Joaquin <br /> Q,omlale C"Gaok <br /> aeilanLLeyVa <br /> 9426 Gonave Dr S,o"o,C496299 <br /> In9r� w0 Enr,,ad flour lblaac wheel gnu[niedn <br /> Iron.IMaml,wm ronNele'nTWlevin,enW ae laao Pahal// <br /> tlec naM tlN mtlk alm eta eal,. <br /> i3WlellMlk.sell,.-11 "a ChM 9 •yv <br /> µams,oi, nol.mak paw rng10e6051,sug dlnul5 <br /> IeaXllin,veMllal,Drown Ilia eamcl,baking ou,a. <br /> OeMrg powtler,eggs.v sailk,W➢.wainirta <br /> Cosaalna:W1,84 a09R <br /> xnwi se:. <br /> 2 of <br /> EHD 16-27 6/29/17 CFO REG/PERMITTING FORM <br />