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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY- <br />9 r.0 <br />COMMISSARY AGREEMENT <br />Mobile Food Facility + Caterer <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />To be completed by APPLICANT <br />Business Name Los Comas <br />Owner/Operator Name Oswaldo Morales <br />Business Mailing Address 5300 Maximillian Dr <br /> <br />Lic. Plate #4VN3714 <br /> <br />City Salida <br /> <br />State CA zip 95368 Bus. Ph. Alt. ph. 559-656-7256 <br /> <br />ki 14) ( , hereby state that the above information is current, true and correct to <br />the best of my knowledge 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 ap4.penalties. <br />kkdQ Date 06 -02 - 2y- <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name Max's Kitchen LLC <br />Address 1211 S. 7th Street <br />City Modesto Zip 95351 <br />Check all appropriate services provided: <br /> <br />Bus. Phone 209-338-3663 <br /> <br />Owner/Operator William Berkowitz <br /> <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />1, Mark Luis Cruz <br />3-compartment sink <br />Food preparation <br />Store refrigerated food <br />Er Overnight parking <br /> , hereby state that the information <br />Electrical hook-ups <br />Toilet and handwashing <br />0 Potable water <br />EJ Vehicle wash <br />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 owner sha otif the EHD immediately. <br />Signature Date % /2r7 <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in 14\--Sk4QS 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. Please notify EHD if th status of their operating permit changes. <br />Date -7- <br />1868 E. Hazelton Avenue I Stoc , California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />AZ24 00271 <br />Signature <br />FA# <br />REHS Signature