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" . . <br /> ! . ^ <br /> i <br /> � Environmental Health Department� AN � 0U1W <br /> COMMISSARY AGREEMENT <br /> Mobile Food FaciiitY ° caterer <br /> Conole/esections Yand 2. //your mmmmsary is located outside of San Joaquin County also cofnplet»section 3. <br /> I. To be completed b :APPLICANT <br /> Cit un�tLk State C Zip ;,31L Bus. Ph. 2,A) �q2_'fYN <br /> _LL 24 <br /> 1, Aelpin(L jj!:p L�\r6 hereby state that the above information is current, true and correct to <br /> the be�t_o`F -my knowledge and agree to utilize my approved commissary in accordance with California Health '�i <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 EFID. Failure to notify this office mav result in Pez— <br /> rovocaUonandoeno|hes <br /> Signature Date <br /> Z. To be completed bv COMMISSARY OWNER/OPERATOR <br /> Commissary Name California Catering Food Service & Supply FA <br /> � . <br /> Address Bus, Phone <br /> '-w Stockton Zip 95206 Owner/Operator <br /> 2i,eokall appropriate services provided: <br /> � Wastewater �� 3'oornpo�mentoink �� Electrical hook-ups <br /> So|idvvasbadiapnsa/ Food preparation �� Toilet and handwu»h/ng <br /> -` Srefrigeratedfn d �� Potable � <br /> Hot & Co|dwe�er8orn{ean|ng 0m Store o ~= wa or <br /> m� �� <br /> food/suppliesOvernight perking ww Vehicle wash <br /> . oornbystate that the information |have provided is current,true and <br /> ��rremmT'e b�s`i of my knowledge,and meets the California Health&Safety Code requirements. Ifthe food facility <br /> operator fails tocomply with the conditions ofthis agreement, orif this agreement iumodified orcancelled, the <br /> Shallowner not he EHDimmediately. <br /> ,-':�;nature Date 12, /it <br /> 3. To be completed-by the_ENV_-_,KEALTH jun'sdidon outside ofSan Joaquin C <br /> The commissary iulocated The above food facility meets the <br /> ,-ommissary requirements in California Hoo|Uh & Safety Code, The mUuvo checked services are available at the <br /> pbove commissary. Please notify EHD if the status of their operating permit changes. <br /> REHS Signature a| <br /> ��58F. Haze|1onAvenue | Stockton, California A52U51 T 209468'34281 F 208484-U138 |wwx*.m|gov»ng�hU <br />