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SAN JOAQUIN <br />CC)l!i�!TV <br />Environmental Health Department <br />El Sweet Sorghum ❑Roasted Coffee Syrup (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 http7//w .aoressdata,fda gov/scripts/cdrh/cfdocstefCFR/CFRSearch tiro?CFRPart=150 <br />Food Descriptions <br />Vl acamos w%\\ Somt-\\ywS lnc de-cozckeA woth <br />i��l�n.Ft\\tf�c. tiA\-,CJ0uN\V.S cef\\ a1n <br />Scnre YyL`�c eco <br />2oi5 <br />EHO 16-27 BQ9/17 CFO REG/PERMrFnNG FORM <br />