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` <br /> � � &0 k�� � �k� � <br /> ����� 8UU�UU�K�N �"—�� �������/��� <br /> --��C}[J ��T\'�' <br /> _ <br /> Rsmy <br /> ` ~— ~"COMM"~ = ARAGREEMENT - : xR.1 ^ <br /> ' <br /> Mobile Food Facility � [|@��r8F Turlock <br /> - <br /> Complete sections Y and 2. IfyourCommissary/s located outside of San Joaquin County also con4//eho section 3. <br /> 1.' T0 be completed by APPLICANT <br /> Business Name Cruising Cones s Lic p|ate 4mB4325 <br /> Owner/Operator Name Patricia Hansen �------__' <br /> PatriciaBusiness Mailing Address 11222 Loduca Dr <br /> City Manteca State CA Z i P 95336 Bus. Ph. 209-800-8079 <br /> Alt. Ph. 209-993-2461 <br /> ams�n <br /> | ��----- <br /> . hereby state that the above information is current, true and correct to <br /> the best of my knowledge and agree to utiliz'e my approved commissary in accordance with California Health & <br /> Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br /> commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and p ities. <br /> 2.,To be completed-bY COMMISSARY OWNER/01PERATOR <br /> LtC- <br /> Check all appropriate services provided: <br /> 21 Wastewater disposal 0'3-compartment sink ErElectrical hook-ups <br /> ff 8o/id waste disposal T�rFnod preparation Z, Toilet and handvvaahing <br /> ffHot & Cold water for cleaning �/Store refrigerated food 2--l' Potable water <br /> 121 6tna dry food/ |i 2yOvernight hi ��v <br /> ehio|e wash <br /> |, hereby state that the information | have provided iacurrent,true and <br /> correct tuthe best ofmyknowledge, and meets the California Health &Safety Code requirements. |fthe food facility <br /> operator fails to comply with the conditions of this agroement, or if this agreement is modified or canueUed, the <br /> commissary shall <br /> Signature Dat <br /> 3. To be completed,by the ENV HEALTH jurisdiction outside of San Joaquin :Co. <br /> The commissary is located in stan,s/ans County. The above food facility meets the <br /> commissary requirements in California Health & Safety Code The above checked oen/i000 are available etthe <br /> abovemino Please notify EHD if the status oftheir operating it changes. <br />