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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY•— <br />Greatoes:, grav,s here, <br />COMMISSARY AGREEMENT <br />Mobile Food Facility < Caterer <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />To be completed by APPLICANT <br />Business Name Tacos Aldia-Mante LLC Lic. Plate #4VF6237 <br />Owner/Operator Name Jorge Barriga <br />Business Mailing Address 227 Coronado Way <br />City Tracy State CA Zip 95376 <br />',-26 .14;1 , hereby state that the above information is current, true and correct to <br />the best of my knowledge and agree to utilize 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 hol r must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. <br />Signature <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name Max's Kitchen LLC <br />Address 1211 S 7th Street <br />Bus. Phone (209) 338-3663 <br />Bus. Ph. (650) 339-8494 Alt. Ph. <br />Date 6 1711,e/g1 <br /> <br />FA# <br />City Modesto <br /> <br />zip 95351 <br /> <br />Owner/Operator William Berkowitz <br /> <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />1, Mark Luis Cruz <br />3-compartment sink <br />Food preparation <br />Store refrigerated food <br />Overnight parking <br /> hereby state that the information <br />GI Electrical hook-ups <br />0 Toilet and handwashing <br />0 Potable water <br />Ea Vehicle wash <br />I have provided is current, true and <br />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary owner shall notify the EHD immediately. <br />Signature <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in County. The above food facility meets the <br />commissary requirements in California Health & Safety Code. The above checked services are available at the <br />above commissary. Please notify EHD if the status of their operating permit changes. <br />REHS Signature Date <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />Date <br />P12 oSL1V(g