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i <br /> � <br /> | . <br /> ` <br /> �� � 4� Environmental��,�«� � |� °_ �" ��` , ' _'. _ <br /> `OMMKSSARY AGREEMENT <br /> l8Food FacilitY � caterer <br /> anoYandI �,nuroommmae/v��ca(edou��eo{San JoaqumCounty*� � <br /> 000n� teea«»»»:' <br /> comoieted bv AP <br /> PLICANT <br /> _'-sii-lessName W.JoL6 Lic.Plate# <br /> State Q, ZiD <br /> hmahvstate that the above information iscurrent.true and correct'r; <br /> the to utilize my approved commissary inaccordance with California Hpn'N­ <br /> Safety Code. and San Joaquin � Environmental Health DeDartment (EHD) mouimmentsIf the use "'I^" <br /> commissary is discontinued,th�j perphit holder must notify the EHD. Faflure to noti1y this office may resuit in Dem", <br /> revocation and enai-4 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <br /> NameCalifornia Catering Food Service & Supply _FA# <br /> Address-2440 Bus, Phone <br /> ��iv Stockton Zip —Owner/Operator <br /> aK aDpnophaie nan/i000 provided: <br /> VVastnwmherdiapuae| t3' 3'cnmpartmentaink 13 Electrical hook-ups <br /> jN Solid waste disposal Food preparation Toilet and hmndwashmg <br /> |!ot& Cold water for cleaning Store refrigerated food Potable water <br /> It Stqre dry food/supplies overnight parking EWVehicle wash <br /> riereby state thatthe information|have provided iucurrent, true and <br /> - frect to the'"6est 6f my e'andmeotmtheCoUhzmioHeokh&8a0etyCndenoquiemon\o. |fthe hmdtacU|ty <br /> .ponatorto/|s to comply with the conditions ofthis mgnuemen\, or \fthis agreement iumodified or cancelled, the <br /> `=:mmaamowner snail notify the EMDimmediately. <br /> 3ouxb*xsoxU an"Quisidd-oftin Joaquin Co. <br /> The uommisoary [slocated in County. The above food fauUi\ymeets the <br /> 'ommmuarynoquinymen<a in California Health & Safety Code. The above checked services are available at the <br /> �boveoomm/uaary. Please notify EHDifthe status nYtheir operating permit changes. <br /> REHS Signature at <br /> YG8n ' ne| Shock�on.�u|/homiaUS2O5 \ T 20Q�G8'342U� F JOQ�84-0118 )wi`E. Ha��|�onAvenue <br /> 0�� U�Q | »� <br /> �� x � \ �~i �yL_ <br />