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❑ Dried or Dehydrated ❑ Dried Vegetarian- ❑ Vegetable and Potato Chips <br /> Vegetables Based Soup Mixes <br /> Sweet Sorghurn Roasted Coffee ❑ Chocolate Covered Nonperishable Food <br /> ❑ Syrup ❑ (Beans/Grounds) <br /> ❑ Fried or Baked ❑ Dried Hot Chocolate ❑ Fruit Infused Balsamic Vinegar <br /> Donuts and Waffles <br /> ❑ Other <br /> Oo 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 Regulations <br /> htt .Ilwww.accessdata.fda, ovlscri tslcdrhlcfdocslcfCFRlCFRSearch.cfm?CFRPart=15Q <br /> Food Descriptions: <br /> Pla;,r, 5 undo MbnecxcA kocki <br /> d OU Y'lect ca <br /> l7 lE t , o�r�n bra 1 to F <br /> cal v-, d r C> -e ct of to o f <br /> kJ <br /> Co e CA1L-e S0u1C-dGU2Jkn JoCk f <br /> P61(-n- e4n a,nd r-eevl an kQnL oc.G lr, br�c�d _l oa <br /> V) S _ , <br /> EHO 15-276/29/2023 2 CFO REG/PERMITTING FORM <br />