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-3 ii�J4JjiC�?�3�14rtFif Qw Ete(�1$b'S�'r sv«r.32 �l'G�?fi. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility .a Caterer <br />Compiste sections 1 and 2. P; your commissary is !oceted outside of San Joaquin County also complete section S. <br />Business NameS�} <br />owner/Operator Name <br />Plate # <br />City��Yl State � Zip !jDy Bus. P Hit rn. <br />l hereby sate that the above information is current: true and correct to <br />tite best of m 9e and agree to util'�e my approved commissary in accordance with Ca ifomia Health & <br />Safety Code, and San Joaquin County Environmentai Health Department (EHD) requirements. If the use of the <br />commissary is discontirued, the permit holder must notify the EHD. Failure to notify this office may result in permt <br />revocation and ysaaiies. A{ `� l fl I 1 <br />Check ail appropriate services provided: <br />�Wastawater disposal lcompartnent sink > . Electrical hook-ups <br />Z, -'Solid waste disposal �ocd preparation �oilet and handwashing <br />;/'Hot & Cold ,rater for c eaning _ Store refrigerated foodt2"Potable water <br />-" She dry rood suppI' 5— Overnight parking -G vehicle wash <br />hereby state that the information I have provided is current; true and <br />correct to fie best of my Knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails to comoly with the conditions of this agreement, or if this agreement is <br />jj modified or cancelled; the <br />commissary oy6 r4all n9tfy th�:HD immediately h e l l 1 <br />% The commissary s located in County. The above food facility meets the <br />commissary requirements in California Health & Safety Code. The above checked services are available at the <br />above commissary. Please notify EHD if the status of their operating permit changes. <br />RENS <br />1868 E. Hazekor Avenue j Stcck.cr�. Calimrnia 85205 , T 20? � SS -3420 I F 209 464 0138 ; www.sjgov:crgiehc <br />�ODntoy3� <br />