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Environmental Management <br />Department <br />Marie Woodin, Director <br />OUT OF COUNTY COMMISSARY <br />Name of MFF: 0%86 atlm'Pas <br />Name of Commissary: <br />Commissary Address: <br />sivkhr) C9/77muoillY <br />Al EZ-- Donado ,C7L: ‘717)d-/bnei qr,w <br /> <br />If the proposed facility is located outside of Sacramento County, the local Environmental Health <br />Department shall verify that the commissary and/or commercial kitchen has ent health permit by <br />signing below. The establishment is in 50....,r\ —7001 n County ity. <br />An REHS signature verifies that the facility indicated in above meets CALCODE Section 114294-114297. <br />\2--GC\ eak f\C\Q_ (\ 0\ ( <br />Out of County REHS Name (Please Print) <br />(4 CAJ <br />Out of County REHS Signature <br />2_ og - <br /> <br />REHS number <br />t 2_ - cA - 2_02 Li <br /> <br />Date <br /> <br />trOrNo\.re5C <br />Email Address <br /> <br />Phone Number <br /> <br />11080 White Rock Road, Ste. 200 • Rancho Cordova, Callfomla 95670 • fax (916) 875-8513 <br />Environmental Compliance (916) 875-8550 • Environmental Health (916) 875-8440 <br />www.saccounty.net • emd.saccounty.net