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Check Use <br />El Mobile Food Facility <br />Caterer <br />El Temporary Food Permit <br />0 CMFO <br />Preparation or packaging of food fl Refrigerated/frozen food storage <br />yPotable water supply 0 Dry food storage <br />iquid waste disposal facilities 0 Utensil storage <br />aste grease removal <br /> <br />Electrical hook-up <br />0 5.41 Do\ <br />COUNTY OF YOLO <br />Department of Community Services <br />Environmental Health Division <br />292 W. Beamer Street, Woodland, CA 95695 <br />Phone: 530-666-8646 I Email: eheaithfri,yolocounty.org <br />FOOD FACILITY COMMISSARY AGREEMENT <br />BUSINESS INFORMATION <br />Business Name: (A% AV <br />License Plate Number (mobiles only): <br />Owner of Business: 4:1 T;s121,AAAve- <br />Mailing ddress: 1511)2 CACA: WO— VPig-k C14 City: LITT44)C Zip: Cir37rt, <br />Phone: l._4V011-9-- Email: inlo- ceisol piptileecril- cowl <br />I, owner/operator, will operate out of the commissary listed below and report to the commissary at least <br />once each operating day for cleaning and servicing. If I operate a mobile food facility, I will store it at the <br />approved commissary or another approved location. I will notify Environmental Health of any changes to <br />this a! • • .1 ent. <br />huolif <br />Signatur, of Owner/Operator Date <br />Commissary Name: <br />Commissary Owner: /94-tor A 1ç <br />Commissaty Address: iez•IF <br />Phone #: f 3 V--7f 73 Email: ediimil fe: Z.5d) <br />How many food facilities (e.g. food truck, caterer) are currently using your commissary? / <br />-7Aes raVr 6d,17 fe 02e rOlo <br /> Type of Facility: <br /> Type of Facility: <br /> Type of Facility: <br />I, the commissary owner/operator, will provide the food facility (check all that apply): <br />arewashing <br />C3Restrooms <br />(3—Overnight parking <br />(Pa—Truck/Cart cleaning <br />"j-57)6‘3-loo y Y <br />Signature of Commissary/7 er/Operator Date <br />COMMISSARY INFORMATION <br />Type of Facility: pCommissary 0 Restaurant OMarket <br />i,hiLcr?,yf 64i l/b <br />City: 66 4.// Zip: <br />List the food facilities below (use a separate sheet if needed): <br />1. Business Name: <br />Business Name: <br />Business Name: