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SANJ O A Q U I N Environmental Health Department <br />Sweet Sorghum Roasted Coffee Chocolate Covered Nonperishable Food <br />Syrup (Beans/Grounds) J �2 <br />D Fried or Baked Dried Hot Chocolate Other L� R/vn1 32 DSrA tJ�-'TT'E-F— <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 httg/Avww.accessdata.fdagoy/scri tis/cdrh/cfdo__cs/cfCFR/CFRSearcr>Sfm?CFRPan=150 <br />L � e <br />Food Descriptions: aMd bOsa h �aktvt t., U Sc -d 1 n t rvf, 1 <br />�_ I d <br />C OM bn.eak-fAsT Gke <br />�e a me d ro t,tM � �r� cad <br />_CO�t.SiS�.•r 'uCz� <br />� wc�E.eT aMd <br />Stu([, trJt vt - -amQ Ae <br />S iia f 30 Ca, .mss <br />$i�PPA FOODS Wlkk be Commlt+ed t) q <br />ash _ batter R_v_erw d aLt G -A a <br />2of5 <br />EHD 16-276/29/17 CFO REG/PERMITTING FORM <br />