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SA N J O A Q U I N Environmental Health Department <br /> ---COUNTY--- <br /> ❑ Sweet Sorghum ❑ Roasted Coffee <br /> 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 http:/twrww,accessdata.fda gov/scripts/cdrh/cfdocs/cfCFR/CFRSearch cfm?CFRPart-150 <br /> Food Descriptions: <br /> bake] bi-park anz4 OaQPIs <br /> J <br /> EHD 16-27 6/29/17 <br /> 2of5 <br /> CFO REG/PERMMrING FORM <br />