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Dried or Dehydrated <br />Vegetables <br />0 Sweet Sorghum <br />Syrup <br />LI <br />Fried or Baked <br />Donuts and Waffles <br />Other H 4 -1 <br />1--7 Roasted Coffee <br />1---1 (Beans/Grounds) <br />ri Dried Hot Chocolate 0 Fruit Infused Balsamic Vinegar <br />Dried Vegetarian- <br />Based <br />Vegetarian- <br />Based Soup Mixes LI Vegetable and Potato Chips <br />Chocolate Covered Nonperishable Food <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 Regulations <br />http://www.accessdata.fda.goviscripts/cdrh/cfdocs/cfCFR/CFRSearch.cfm?CFRPart=150 <br />Food Descriptions: <br />[ Scal6v ii <br />voCt-11. rx. <br />4 e, c"./ Lt. 56 1.4-• < 5+1-A •14_ ;1415 <br />e 13 6z ,5cet <br />C4.44-Y4-eJ C./Lit; <br /> <br />4 .s <br /> <br /> C CA. D 14. <br />ft_Z (51*_1— /*/ 14.. -547.111 ( 7" •Yd, q. " ps•-/- <br />41i _.51•‘0 A". <br />e4.1 1,` - .vee. vJop tom_ t,t- <br /> <br />END 16-27 6/29/2023 2 CFO REG/PERMITTING FORM