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□□□Vegetable and Potato Chips <br />□□□Chocolate Covered Nonperishable Food <br />0 □□Dried Hot Chocolate Fruit Infused Balsamic Vinegar <br />□Other <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> Contains: wheat <br />EHD 16-27 6/29/2023 CFO REG/PERMITTING FORM <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 Regulations <br />http://www.accessdata.fda.qov/scripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Dried or Dehydrated <br />Vegetables <br />Sweet Sorghum <br />Syrup <br />Fried or Baked <br />Donuts and Waffles <br />Ingredients: wheat flour (organic hard red wheat <br />flour, malted barley flour), water (filtered), active <br />sourdough starter (wheat flour, water), salt, rice <br />flour <br />Dried Vegetarian- <br />Based Soup Mixes <br />Roasted Coffee <br />(Beans/Grounds) <br />Sourdough <br />Country Loaf <br />Blue Cottage Bakery <br />Stockton CA, 95203 <br />Permit # <br />Issued in San Joaquin County <br />Made in a home kitchen. <br />Net wt. 1 lb 14 oz (873g) <br />ot dri <br />incrH <br />Food Descriptions: <br />Cm /1 C ( rW) • Sx/T •_________________________