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SA I r A Q un i I I N Environmental Health Department <br /> COUNTY— <br /> Food <br /> OU NTY`J (� <br /> • • • Production <br /> 1. Indicate the location where you will store food and equipment at the end of the day. <br /> CommissaryMame: He Ili Pi P;z-7, Co, Facility ID#: <br /> Address: Jr D lam✓ TRK ^ Sf T4 cY CA i�-"7 5 376 <br /> MENU DESCRIPTION <br /> indicate all the food and beverage items for sale. WHERE WILL THE FOOD BE PREPARED? <br /> COMMISSARY ON-SITE <br /> FOOD ITEM <br /> 6eAii S ® ❑ <br /> ❑ ❑ <br /> ❑ Li <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 <br /> 11 t5 04✓ <br /> �o ,L P4- <br /> "44'. ;y w�I i �orri <br /> 2of4 <br />