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SAN:;J O A Q U I N Environmental Health Department <br /> —COUNTY— <br /> Sweet Sorghum Ej Roasted Coffee <br /> Syrup (Beans/Grounds) Chocolate Covered Nonperishable Food <br /> ❑ Fried or Baked <br /> Donuts and Waffles ❑ Dried Hot Chocolate ❑ 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 htto://www.accessdata fda-.gov/scriptslcdrh/cfdnes/cfCFRICFRSearch.cfm?CFRPart--150 <br /> Food Descriptions: j �OC h l <br /> I� 11 1r1 <o� <br /> ix <br /> — cA e <br /> o <br /> caon <br /> EHD 16-27 6/29117 2 of 5 <br /> CFO REG/PERMITTING FORM <br />