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SAN 'JOAQUIN <br />Cu NTY— <br />RE.Cel\leP: <br />011RCES <br />PPR 1 1.014 <br />051 1 0,1\11R01.0.01.RE.S <br />Complete sections <br />To be completed by APPLICANT <br />Business Name --raco Al Peso <br />Owner/Operator Name Jaime. ? <br />Business Mailing Address 1164E35 VVe..1- Lards, Road <br /> <br />Lic. Plate # 6,j .945O <br /> <br />City -Tr State CA Zip 9530-4 Bus. Ph.2-09-914 -1E3,295 Alt. Ph. <br />640fe pait4 , hereby state that the above information is current, true and correct to <br />the best of my knowl ge 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 holder 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 />n PN, uel flrUa-K <br />Address ?nolo uu Bus. Phone 9(yii/ I 753 <br />City i)/ ocie 0 zip q 3 Owner/Operator :Tov-e- E-ci rCe_C; <br />Check all appropriate services provided: <br />Ur Electrical hook-ups <br />10 Toilet and handwashing <br />FrPotable water <br />Ft Vehicle wash <br />Ma( c-1 ,hereby state that the information 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 own #r shall rotify the EHD immediately. <br />Signature <br /> <br />Date <br /> <br />(7J O5c,V <br /> <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in Stamslaus 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. PI ase notify EHD if the17status of their operating permit changes. <br />Date '+h 3/2024 <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 />REHS Signature <br />pRosz3335 <br />ss grows here. <br />COMMISSARY AGREEMENT APR 05 2024 <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />Mobile Food Facility • Caterer <br />Date <br /> <br />Commissary Name FA# (90511/ t.V9 <br />4 <br /> Wastewater disposal <br />- Solid waste disposal <br />0 Hot & Cold water for cleaning <br />tc Store dry food/supplies <br />ga- 3-compartment sink <br />14 Food preparation <br />Store refrigerated food <br />CO Overnight parking <br />Environmental Health Department <br />RECEIVED