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SAN 1OAQUIN <br />:rtvironmeht t Health D-ep aosnej, -� <br />COMMISSARYAGREEMENT <br />Mobile Food Facility v Caterer <br />Complete soctiono a onc d: P }' 'Iv loczl G' oarside of San y(lsot:tln County' wso comlydlef� &'dict 3 <br />PPUUVV..�� f <br />Eusiness Name Lir. slate # � <br />Owner/Operator Nania_.1l?( X (A �1 fA. I t ! V) _r <br />/ /A I� <br />Pd uUI41—alt. <br />here. b_,' state that the above information Is current, true and correct to <br />the beat of my knowiedge z:nd agree ro utilize my :a l:raved commissary in accordance with California Health ^a <br />Safety Code, arld San .iiaquin County Mnvlronmenrei Health papartmerd (SHO) requirements. If the use of the <br />commissary is disocrtinuec. the permit holder must notifv tiia RHD. Failure to notify this office may re�ult in permit <br />revocation and <br />��, ate r�aproarlete sdr.lcet i"rruvir�ei'i: <br />a lN� stetdzier di pieal-t;—VC_:nmpAr(ment ,Ank �ectdcaal hook-ups <br />slid evaste dh7posm i =Crod Pt*par don• La Tollst and handwashing <br />�ot & Cold water for ciesning ore reiloigerated food M otabl water <br />SfnrB dry food,'/ uppiies vsmiGht PP. king Vehicle wash <br />1 -- tik r4 y .tete that this information I have provided Is current, truer and <br />correct to the best of my knoll, edge, and meets the California Hec,lth & Set city Coda requirements. If the food faoiliey <br />operator falls t mply with the conditions of this agreement, or If this agreement is modified pr cancelled, the <br />aammissaiy o rsr mil no�ty the,E}1D immediaieiv. ,, 1 I _ r <br />The commissary is ioc ted in County. The above food facility meets the <br />ccmrriis5ary regsiramente In Callfohnirr Het?Itit & Safety Cove:.The above checked services era available a thu <br />r,:oove commieSary. Please notify EHIS If the status of Their oFerating permit changes, <br />1Gw1§ E 4aZalt^n :`4rgni:* I '" ✓,:U_ ru!If:. . n t- :� } . e <br />r � x �-3�.-0 i F :.0? •a $ �; •t•p•,,,P. i t'vs"fh.�J�!7v.tjr�Ir^_"^ne <br />