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SA N.r10 A Q U IN Environmental Health Department <br /> - counry <br /> I <br /> Sweet Sorghum Roasted Coffee <br /> Syrup ❑ (Beans/Grounds) ❑ Chocolate covered Nonperishable Food p <br /> ❑ Fried s Baked ❑ Dried Hot Chocolate Other J—N1 ctrl �L�e Ictt 1�I t <br /> Donuts and Waffles <br /> ' <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 acce data.fda.gov/suipts/rdrh/cfdom/cfCFR/CFRSearch.cfTn?CFRPart--I 50 <br /> Food Descriptions: <br /> p 13 Ayn — s of Z6 ce d; rm d c :5;tn d <br /> ceko J� o b e uch aS o L ,Yeerti I <br /> MA6!n T--v\g dei lel k aye Ve�es, ces <br /> O�e� _4uck '5"-s Gloves; 6- 1VIa.1noo� um;4 teed$ . Mr'0 Iree1/0S e2n3 <br /> ` 'nao,,/ %ai 11c Pmslel <br /> (niG ewi nia — z c .a �Pre�.:l JA ( cfmry made df <br /> bC1r 1nai }oe le'V/11 <br /> �d a i a Co i n Ves <br /> I <br /> I <br /> I <br /> i <br /> I <br /> EHD 1627 6129117 CFO REWERMrMNG FORM <br />