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SAN._JOAQUIN <br />—COUNTY— <br />Environmental Health Department <br />1. Indicate the location where/you will storefoodand equipment at the end of the day. <br />�7� �1c''C !"r Facili <br />Commissary Name: ty ID #: <br />Address: .7-59 _5 a, L.n C,4 <br />MENU DESCRIPTION <br />Indicate all the food and beverage items for sale. <br />WHERE WILL THE FOOD BE PREPARED? <br />FOOD ITEM <br />COMMISSARY <br />ON-SITE <br />%,a/1 6 <br />IISAR <br />El <br />13,60 <br />I <br />Z <br />El <br />❑ <br />❑ <br />El <br />❑ <br />❑ <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 <br />Intended use duringfood preparation or catering event <br />Refrigerator <br />51 f !1l r- <br />70 WyiS w �I.725-.1 -TGA' <br />%,a/1 6 <br />0 P/'/ / f/✓ �C� /r <br />2ofa <br />