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The convrussary a loaded as COutd., 1 to above food %clay meets uye <br />cOrrrnissary rerpavernents in Califorrsa Heath 8 Safety Code. The tbove chocked sorb KOS ere annatabto lithe <br />above commssary Meese notify ENO d the status of their cberabrig permit chandits <br />Date <br />Convms sary N nolo ss-T CNC_ ._,._Ls..,. in.., ii..1 vi,ta___ I Al <br />Address % la 1-4 dt.., caoRisao IsT • —Bus Phone (pCrat) 443 - 2t04 <br />City "Sii-TC:icacTos.$ zip fl.S mos. Chsrbon'Oparator_S,Z9S4W., C:./1/41:7 ti..3-0 - C.c> co‘bu.s Dela <br />Chock al, anemone. services provided <br />613 Wastewater disposai OIL 3-compartment sink ig, Eiectricat hook-ups <br />si So:id waste dispose: 0 Food preparation SI Toilet and handwashing <br />Hot al Coo water tcr cleaning 0 Store 1'4/nonrated food id, Potebte water <br />Store dry foocusuppties 0 Gwerwigast-peorwdr 0 Viefweioweitas- <br />I. LEOUEL CASTat...Lo .1,,,.by six,o u,ot theht0r.r.V.On . have provided is Cbarent this and <br />Cdcroct to No best i : 4 My knatnod3o. and moots the Gallons a Hoorn A Seely Coda requiremente if the few leomy <br />cip0fabOr 'Will 10 Comply with the Condit:OM a Ch.% akroontnnt Or 1 this Woodyard IS trcdfred Or cancelled. the <br />Oomrnrssary all notify EtID immodiato/y <br />& reruns _ p ____441— Date <br />asM-3 cbiTilid PDAUMIWATITIOAdict_Lon1111111ENIgi-A <br />Rr.Hs svnaturo <br />1 668E a-Welton Arent* Stockton C 4om <br />95205 I T 209 4684420 F 209 484-0138 I veAvi s,gov cx9'end <br />SANJOAQUIN <br />weos COuNTY <br />11 ,•••• N.. <br />Fnvironmental linalth Donartinent <br />COMMISSARY AGREEMENT <br />Wale Food Fatality • Caterer <br />Comeise• an. and 2 t I your corwassaarsin toobOndovlataa of San bap*, Cowry Woo canvas.* aistisan 3 <br />Business Name Pi.? 45. Uc Plate <br />OwnetiOpenslo, Ham* °un- Geb C•CtitbalSPs- SAAINTQ <br />fistSiktoss Wising Address IC. IV pitsi-i 1MA WA'? <br />I.. skAkke - hereby Mae trer ISO Karns WOOroblittiOn is oatnink Kw and coned coned <br />Al Ph City IAA GA State GA Zap irtiMtie Biro Ph <br />Pt* but of ett3 knowbadp• and liana 10 *Akio my aporosod okonsaaani wr isocontlanos wob Calsornia Hrair <br />Sokttey Coda. and San !moon County Environmental /100101 Obso•enswit (EH01 r um..it It tea wae of Inv <br />commits/try <br /> <br />Is tdobooniniabd. Ino permit hotikw must notify is. t Vit-u.. to mots dui onto• mos rossnor ponwi <br />Data \,/(444 (:1' Signas.ios <br />revocation and <br />1.2gOtO lumnieWegl7Y7L_:OCWM ---4tigeMill.1111111" <br />Fizost-n-5o3