Laserfiche WebLink
SAN I�AQUIN Environmental Health Department <br />COUVTY-- <br />COMMISSARS AGREEMENT <br />Mobile Food Facility * Caterer <br />Complete sections f and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />Business <br />Owner/Operator <br />Plate #-�T <br />i I hereby state that the above information is current, true and correct to <br />the best of my Iamwledge and agree to utilize my approved commissary in accordance with California Health & <br />Safety Code, and San Joaquin County Environmental Health Department (EHO) requirements. if the use of the <br />commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and petRalties. Q J a, /I I <br />k ail appropriate services provided: <br />Ch <br />17wdisposal G1`13 -compartment sink <br />f—�/ lid waste disposal l Hood preparation <br />Erj4gt & Cold water for leaning E2& re refrigerated food <br />Store dry food/supplies ernight parking <br />hereby state that the information I have provided is current, true and <br />knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />with the gonditions of this agreement, i if this agreement is modified or cancelled, the <br />I, <br />correct to the best of <br />operator fails to <br />commissary o s <br />C?IE-lectricai hook-ups <br />0Toilet and handwashing <br />0�-Potabie water <br />ehicle wash <br />The commissary is 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 />REHS <br />1868 E. Hazefton Avenue I Stockton, California 952051 T 209 468-34201 F 209 464-0138 i www.slgov.crglehd <br />pRos017-Z s <br />