Laserfiche WebLink
Department of File# <br /> g0�ghp Resource Management <br /> 675 Texas Street,Ste.5500 <br /> Fairfield,CA•94533 <br /> wwwsobnoeounty.com <br /> cgur.t� <br /> Environmental <br /> Health Division Jaglmder Sahota,RENS <br /> (707)784-6765 Environmental Health Manager <br /> COMMISSARY AGREEMENT <br /> *Completion of this Commissary Agreement is required prior to issuance of Solaro County Permit to operate a food vehicle* <br /> COMMISSARY INFORMATION <br /> I hereby certify that I possess a valid environmental health permit to operate a commissary as defined in Sections 114211, <br /> 114245.1,114294-114295, 114301 and 114326 of the California Retail Food Cade(Cal Code). <br /> CommissaryName: U /v 1 U 4� c Pa C- I,S N G T u c K ce iy—kc-R <br /> CcmmL%WAddmss: (717 -S . U N(o lv sT. ��TE C��t j LIg <br /> Commissary Owner'sName: �S)jL\)61DC)R 7(PUbQ Telephone: Cacq) �ct 5't I <br /> Type of Facility: ❑ Market ❑ Restaurant ❑ warehouse [Pother. COT&¢,I `L LC LT✓(NN i'iIUARv <br /> I hereby certify that the following vehicle is operating out of the above commissary: <br /> 44 5 G ay-'s Tp,(-T e 4 'B 60 q35'? r <br /> Vehicle)Business Name License Plate# <br /> 1,the commissary owner/operator,agree to provide the following necessary facilities for the above mentioned vehicle at my <br /> permitted facility as checked below: <br /> [y'Food preparation [Utensil washing [(�efig.lfrozen food storage <br /> [,r Potable water supply [ Dry food storage M Supply/equipment storage <br /> [4}F ood product supplier I:fpquid waste disposal [electrical hook-up <br /> P]Vehicle storage [r]'Garbagedisposal [�rRestrooms <br /> I agree to notify Solano County Environmental Health of any change in the status of my operation or when this commissary <br /> agreement is no loo er dtA copy of the current health permit is provided. <br /> ART T/RAS5///-z() 6 <br /> Commissary owner an <br /> mager Date <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> If the commissary is located outside of Solano County,the local environmental health jurisdiction shall verify the suitability <br /> and permit status by signing below. <br /> The commissaryis located in JC)LAv\ County. <br /> The above establishment meets the commissary requirements pursuant to Cal Code Sections 114211, 114245.1, 114294 and <br /> 114326.The above checked facilities are available at the proposed commissary. <br /> Signature of County RENS Date <br /> R--%E II.TMFS MON1MOBnEFOODFACRHMS\COA9vIISSARYFORMdw <br />