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SAN JOAQUIN <br />--COUNTY <br />Environmental Health Department <br />1. Indicate the location where you will store food and equipment at the end of the day. <br />Commissary Name: L" i U/ EST KC T 6L_&/LZ Facility ID #: 40017,<140 <br />n �+t1rn,, fit^ � "� I1' <br />Address: `�► Ito S• t�!/CfCfll�rc UY• ? —On/ <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 />k5 (e <br />E�' <br />❑ <br />1�� fiLfie❑ <br />Cllr-1Cc-N CURRY <br />� <br />❑ <br />9C -,CF klgOR 3 <br />Er <br />❑ <br />Ce7ET118L6 6ZORMA <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 during food preparation or catering event <br />Refrigerator <br />n� <br />d f <br />e <br />3--fo„/P sny' <br />ut <br />2of4 <br />