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SA4:10AQUIN <br /> <br />Environmental Health Departme <br />COUNTY- <br />J.r <br />COMMISSARY AGREEMENT <br />Mobile Food Facthty • Caterer <br />Caraphia tisollaaa I and 2. If your coennyssaary 1 hauled otilsocle of San Joaquin County also coatploas titsccon <br />Totiercompligegillb 3 <br />Business WPM' 9,0,,--)a -:firlyk' 5 ur-Pimios <br />Owner/Operator Nam* JrnALXIWP-01" <br />8 us.neftil Me ling Add( &WI I I.Oc9D 14CAT Ian qt%lk <br />Co 14.‘"A-W SilatarreLZIP 53c) sus. Ph r9rgzaavot4R M Ph <br />I javyi • hereby state at the above information IS arrant true end ocanect b U'. beef at wit knoisiedoe Ind egree ID Lieu my approved ciornmissary viecr.ordance with California Health & <br />Safety Cede. and Safi ..10110Afl Gainey Emelt:omelets' Hearth Departmerd (E Di requirements rr tie use of the <br />(drernassary Y5 discontinued, i. pans* holder must notify the END Farfure to nutty this office may testa in perrne <br />re.rocatIon and penarbesz. <br />Sagnature D <br />2.To be cW6411171WOMERIWERATORIOMIRMIONPIr <br />cornmiguvY Niuns.L. ; id a • '' • t . • • I; FM 007 /93 <br />Addrtss j to 217 4 • Bus Phone ,•20, - 7/ 2— 94..342 .. <br />Criecik ail appropriate sannoes provided <br />City Ltr-t-; Licr2.‘2, Zip 9,s -so Owner/OPer RA atOf_ 54-444. TA s....Ef <br />iiWastewater disposal 0 3-compartment sink a(Electncal hoCe-ups <br />gi S.:AA waste disposal 0 Food preparation ffiToilet and handwashing <br />0 Hof & Cold water for dewing 0 Store refrigerated food riPotabie watle% <br />0 Store dry foolsuppries ii(Overnaght partung aKetude wash <br />correct to tai best of my iknowl <br />I 1514.11k:--'11—fia ryisefc;.1 hereby cats that the ontnit, -.11',,,,- ' 4 ,re pr.:reload .s current true and and meets the Ca/riot-ma Health 65.atui ty woo requirements If Ihe food tensity WI I0 orampty wall ft* condons of the agreement or if VIVI agreement is rirxidefied or the convrassary ,, at EHD med <br /> <br />Signatare <br />3. To conp4etadtI j <br /> <br />rhe cornevesary is located in county The above loOd leaky meets c..nrreSeary requirerronts wi California Heath & Safety Code The aDove titeraad farnaCee as available et the atxwe ribairrwesary Plena notify DID of the status of their operating permit changes <br />REJ1S &vulture Date <br />19& C .azerui Avenue I Skicitdit Cardona/ c.15?0`_p T 209 466-34201 F 209 464 -0118 I twAv_soovergii•ho <br />.44411 dint_ s 5 <br />TRos4oiti2