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SAA' J O A Q I I I N Environmental Health Department <br /> COUNTY <br /> Food • • • <br /> 1. Indicate the location where you will store food and equipment at the end of the day. <br /> �/r <br /> Commissary Name: ll\gy fSl eoR k%) �► `F& Facility ID q: <br /> Address: X10 IQ- [I Ynr�c7 S�. �IjD 10 0- Clp� q' 10 ., <br /> MENU DESCRIPTION <br /> Indicate all the food and beverage items for sale. WHERE WILL THE FOOD BE PREPARED? <br /> COMMISSARY ON-SITE <br /> 1 FOOD ITEM <br /> `c 1� %.ic�t. et r`+V��+�oJr�S, bran r��L d� i r`oa� I /I ❑ <br /> El El <br /> \ I � lJ ❑ <br /> Vz, <br /> `�J'Kl� �,1aP,� lam) �Q"�^ �p�J4�✓� rour,Sl <br /> cj,__ c.,.a. or- <br /> �,,Sk3 S".4 S AWl 1t^Q,, ��� a�.�Y�� a ❑ <br /> �or Il_ ,%0-p %A) aoV5 O,pPkh, �OhbxO X11� P���S ISQ�/��� LJ ❑ <br /> M j%1o,r 1` J <br /> 2. List equipment and utensils that will be used. Please be specific on equipment's use and function. <br /> For example: Equipment: Blender Intended use: Make Smoothies <br /> Equipment Intended use during food preparation or catering event <br /> Refrigerator Cobl (-Do g <br /> ST <br /> c�1 � <br /> owe- >a c.-�.r, I Go• n6 c•La.-t v n x <br /> Gal1v0-�`�0� o�t,n. rorcsli�+ `�b�J -r toe •� �1v <br /> 61L;ScA, IT <br /> 1v0(IC� <br /> , VA k <br /> 2of4 <br />