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Department of Resource Management <br />675 Texas Street, Ste. 5500 <br />Fairfield, CA • 94533 <br />www.solanocounty.com <br />File # <br />Environmental Health Division <br />(707) 784-6765 <br />COMMISSARY AGREEMENT <br />*Completion of this Commissary Agreement is required prior to issuance of Solano County Permit of a Food Facility. * <br />Vehicle / Business Name: <br />Commissary Name: <br /> <br />Pp;cs 1101zGi .e4,0-74.6 <br /> <br />All/044.444- <br /> <br />E - PrCs e4(,9 -ev if-vF /P7 ti/y/tvf oit <br />4/- Commissary Owner's Name: Telephone: <br />Type of Facility: 0 Market 'ErRestaurant 0 Warehouse 0 Other: <br /> <br />I, the commissary owner/operator, agree to provide the necessary facilities for the above-mentioned vehicle at my <br />permitted facility as checked below: <br />[-4FOod preparation <br />[A/Potable water supply <br />[..A4Food product supplier <br />[,Yftestrooms <br />[-ithensil washing <br />P-11Diy food storage <br />[Xiquid waste disposal <br />/ cart storage (N I <br />/ frozen food storage <br />kitupply /equipment storage <br />[--Ttlectrical hook-up A C\.. <br />['Garbage disposal <br />I agree to notify Solano County Environmental Health of any change in the status of my operation or when this <br />(J\ <br />o S <br />E.H. DEPARTMENT AUTHORIZATION (REQUIRED) <br />The following information shall be completed by the local E.H. Department if the food establishment / commissary is <br />located outside Solano County: <br />The food establishment / commissary is located in c:7.1"‘ OcAoi v1 /4..• County. <br />The above establishment is in good standing with the local E.H. Department? X YES NO (explain below): <br />Out of County REHS: ‘4.0.6 e.o, tvve L (\Ka( f'S c\>404.114.-ey-'2 Li • 1 1 • 2 H <br />Print Name Signature Date <br />I certify that, to the best of my knowledge, the above information is true and that I will comply with all applicable local, <br />city, county, and state requirements. <br />Vehicle / Business Operator: <br />Print Name Signature Date <br />Commissary Address: <br />commissary agreement is no longer valid. A copy of the current health permit is provided. <br />Commissary Owner/ Manager Date <br />4