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SAN JOAOUIN Environmeotal Health Department <br /> CCIUNTY <br /> COMMISSARY AGREEML#1� '„�!*”' <br /> Mobile Food Facility• Caterer <br /> Complete sections 1 end 2. If your commissary is located outside of San Joaquin county also complete section 3. <br /> ;� co sled b A P (CANT <br /> ausiness Name Big G's House Corp. Uc.Plate#4SN5273 <br /> owner/Operator Name Greg Chambers ' <br /> Business Mailing Address 2336 Orchard View Cir <br /> city,Modesto State CA Zpg5355 Bus. Ph.20g-312_ -4932 Alt.ph <br /> Greg Chambers , hereby state that the above information Is current,true and correct to <br /> the best of my knowledge and agree to utilize my approved commissary in accordance with Cal'ilomis Health & <br /> Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use 01 the <br /> commissary is discontinued,the permit holder must notify the EHD. Failure to notify this office may result in pernit <br /> revocation ar1r�4ypenalties.r <br /> Signature�"r�'f U�— Date 4P 77� <br /> sled b COMMISSARY OWNER/OPERATOR <br /> Commissary Narmali Comisaria Modesto FA# <br /> Address <br /> 1211 S 7th St. Bus. Phone 209-338-3663 <br /> city Modesto Zip95355 Owned0peratorCold Storage Commissary Inc. <br /> Check all appropriate services provided: <br /> 0 Wastewater disposal 3-compartment artment sink 13 Electrical hook ups <br /> fa Solid waste disposal preparation aration IM Toilet and handwashing <br /> P <br /> IT Hot&Cold water for cleaning 6d Store refrigerated food <br /> Ld Potable water i <br /> overnight parking ( <br /> � Store dry food/supplitas 9 P 9 Q Vehicle wash <br /> I Mark Luis-Cruz hereby state that the information 1 have provided is current,true and I <br /> correct to the best of my knowledge,and meets the Calftmia Health&Safety Code requirements. if the foodfacil'Ity <br /> operator fails to comply with the conditions of this agreement, or ff,this <br /> agreement is mod'Iffed or cancelled,the <br /> commissary II notify the EHD immediately. Date ���03 � <br /> Aida a <br /> Signature / <br /> HEALTHurisd`icton Wide of San Joa tiro Co <br /> (6�,� County. The above food laciffty meets 1 <br /> The commissary is located in Code. The above checked services are available at <br /> commissary requirements in Califomia Health & Safety <br /> above commissary. Please n ' EHD if the status of their operating permit changes. /3 <br /> Date � <br /> REHS Signature <br /> 18N E. Hazefton Avenue I Stockton, California 952051 T 209 468-3420 F 209 464-0138 I www,s190v.ol <br />