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SAN YJOAQUIN <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: S h6Y A -C -f <br />1S Q (3 <br />Facility ID tf: <br />O 4 O 50-? <br />Address: e�L�J 6 tTGtS/ ,, <br />�' ems- <br />YA / C—fi+ q9 <br />--S 7 <br />El <br />Ca - di, ed3 016Avle W6,1<ic, .r <br />u , A--& v 7 .r- ,101-e3 <br />MENU DESCRIPTION <br />Indicate all the food and beverage items for sale. <br />WHERE wnLTHE FOOD BE PREPARED? <br />FOOD ITEM <br />COMMISSARY <br />ON-SITE <br />Z1 <br />El <br />Ca - di, ed3 016Avle W6,1<ic, .r <br />u , A--& v 7 .r- ,101-e3 <br />❑ <br />IJ e,e-e.- c.ev _ z Ora n -LT- <br />l T- <br />C1�6v�re �1aY Se�ai <br />C <br />© <br />❑ <br />ter` ce. - INWh ,...'a' fix✓\ � L w�.b-ir' <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 />kL� Y' <br />IV \�,ks e o o � <br />C U <br />u , A--& v 7 .r- ,101-e3 <br />2 of <br />