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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 />Commissary7N,ame: C , A of f VQI/�/ /z,A _4 t` Facility ID #: DG Z O6 (a3 <br />Address: � 61 -S Gu.r d' % f.7 -1(o <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 />FMPA-1 4014 bc)(AGH, co/L,J 000 FOLt tL /'"�- <br />PAP 4-y A SHE D /2K %�c 3 / iClla l GC�an fSA <br />Imo' <br />LJ <br />❑ <br />.0—AfEL l tl &s (PD/LK f epiCKEirJ) <br />❑ <br />Ir"' Fes✓ <br />c>✓1 � C.�O �GH <br />❑ <br />❑ <br />4�3Q/' <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 />Aeft ra <br />1 <br />W,4" )!I Ew.S <br />C,-2 <br />Ir"' Fes✓ <br />c>✓1 � C.�O �GH <br />4�3Q/' <br />e17 cep <br />L12m1'1- %�GL�� 2of4 <br />