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SANJ U A Q U I N Environmental Health Department <br /> OUNTY <br /> ❑ Sweet Sorghum Roasted Coffee E] Chocolate Covered Nonperishable Food <br /> Syrup (Beans/Grounds) <br /> ❑ Fried or Baked Dried Hot Chocolate Other FLA Ad <br /> I h(t <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 http://www.accessdata.fda.gov/scripts/cdrh/Cfdoes/cfCFR/CFRSearch.cfm?CFRPart=150 <br /> Food Descriptions: <br /> F0'A LLSVief10+1 aVwk i^ rY-��f��✓K.�A/tn(40A 'Ar-C Cff,Li-VE to <br /> }{•iS �uclLcf. d <br /> 2 of 5 <br /> EHD 16-276129/17 CFO REG/PERMITTING FORM <br />