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COOKING FACILITIES <br />FOOD & EQUIPMENT DRY STORAGE <br />POTABLE WATER SUPPLY <br />GREASE/OIL DISPOSAL <br />ELECTRICAL HOOK UP <br />E YES r, NO <br />r YES r NO <br />F YES r NO <br />F YES 7 NO <br />YES r NO <br />ENCLOSED OVERNIGHT PARKING (CARTST- YES r NO <br />MFF OWNER/OPERATOR INFORMATION <br />MIT. OWNER/OPERATOR, will operate out of the above-mentioned commissary and report to the commissary at least on each <br />operating day Ire rig and servicing (as noted above) ICRFC Sec 1142971 I will store at the MIT at the approved. 1• y or <br />another approwd Inc:n overnight Inot RI residence) I wit notify San Mateo County Environmental Health SeriiIces i writi a nv <br />changes to this agri--,irerit <br />pops 2 al 3 <br />Signature: RENS ft: <br />E-Mail: . Cr. 5 1 5+-D?f, Date: <br />0 1') <br />REHS Name <br />Phone *, <br />new llY112020 <br />#44 *Ab2 WO Nano COUNTY NIALT/4 <br />00 ENVIRONMENTAL <br />V-) HEALTH SERVICES <br />nvironmentsi tfeetth awn*, r <br />2000 Alameda de las Puicas Stile 1100 <br />San Mateo CA 94493 <br />PHONE (650)372-6200 I FAX (650)627-8244 <br />unchearth org/food <br />COMMISSARY AGREEMENT FORM <br />SAN MATEO COUNTY COMMISSARY E OUT-OF-COUNTY COMMISSARY' <br />liEDLORES OUT- OF-COUNTY EMIR° MIENTA L ALTh VEFUFCAT1ON BELOW <br />FOR MULTIPLE COMMISSARIES, SUBMIT A COMPLETED COMMISSARY FORM FOR EACH LOCATION. <br />COMMISSARY INEORMATION <br />COMMISSARY NAME. CITY VIEW COMMISSARY OPERATOR NAME: CATHAIR DONAGHY <br /> <br />COMMISSARY ADDRESS: 900 AVENUE D crryizip: San Francisco <br /> <br />COMMISSARY PHONE ft. 4155428099 <br /> <br />COMMISSARY FAX #. <br /> <br />COMMISSARY E-MAIL: GitYviewcomirgssarYO9Mail-C4M <br /> <br />COMMISSARY TYPE <br />r RESTAURANT r COMMERCIAL KITCHEN j VEHICLE COMMISSARY r OTHER <br />COMMISSARY OWNER/OPERATOR AGREEMENT <br />I, COMMISSARY OWNER/OPERATOR, VVILL PROVIDE THE FOLLOWNG SERVICES TO THE MFF APPLICANT <br />FOOD PREPARATION AREA r YES r NO <br />REFRIGERATED/FROZEN FOOD STORAGE I- YES I— NO <br />WAREVVASHING AREA F YES I— NO <br />LIQUID WASTE DISPOSAL F YES 7 NO <br />GARBAGE DISPOSAL COOKING FACILITIES r YES r NO <br />OVERNIGHT MFF STORAGE F YES r NO <br />C0Mt.4ISSARY OVINER/OPER'ATOR hereby deciare that I ho/c1 a %raid Environmental Health Services perrn4 to operate a commissary as <br />defined by the Calrfornia Reta‘t Food Code, Chapter 10 'Note Include copy of valid Heath Permit for Out of County Cnrnmssanes I will <br />notify San Mateo County Environmental Health Services in writing of any change in the status of my operation health permit ot upon <br />termination of ens agreement <br />Print Owner/Representative J)4i'ly17 Signature <br /> <br />Date. <br /> <br />MFF BUSINESS NAME: Braz Burger LLC LICENSE PLATE # 4uB431 3 <br />Print Owner/Representativ e: Anderson de melo Signature: Date: 02/21/2023 <br />OUT OF COUNTY ENVIRONMENTAL HEALTH VERIFICATION <br />If the proposed cornir,ssary s outside of San Mateo County, the local environmental health tunsrachon shall verity the Loa neat h <br />penile is yaw by signing ciel,...ne Countyksty verifies the above mentioned conviussary meets the requaernents <br />nt the Calliomia Retail F nod Code, Section 114294-114297 and 11.132fi The above jiecked reqUiternents are eatable at the comniissary