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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />Sweet Sorghum LIII Syrup <br />Roasted Coffee <br />(Beans/Grounds) LII Chocolate Covered Nonperishable Food <br />Fried or Baked <br />Donuts and Waffles D Dried Hot Chocolate D Other <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 http://www.accessdata.fda.00viscripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Food Descriptions: <br />iLr- ouuli, 4-OcCac Cc& <br />0 (Air ci cint'l C 0 0 <br />\ <br />SCkt‘r. tA, 0,) <br />2 of 5 <br />END 16-27 6129/17 <br /> <br />CFO REG/PERMITTING FORM <br />Scanned with CamScanner