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Environmental Management <br />Department <br />Jennea Monasterio, Director <br />Name of MFF/CMFO: <br />Name of Commissary: <br />Commissary Address: <br />�1 <br />{q L,IFOR <br />OUT OF COUNTY COMMISSARY <br />-701 PAA le s <br />2s-1 S C, ui I A 1 -on 1 CA °I 521-1(7 <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 a current health permit or is <br />approved by signing below. The establishment isln�County/City. <br />An REHS signature verifies that the facility indicated above meets CALCODE Section 114294-114297. <br />l�acleo�nne L�>nhrnr� <br />Out of County REHS Name (Please Print) <br />Out of County REHS Signature <br />2- 3q- to 1 b-- 3 025 <br />Phone Number <br />-ti-- -1 S9 <br />REHS number <br />Date <br />Email Address or\ y <br />PR -o ti g23C:) <br />11080 White Rock Road, Ste. 200 - Rancho Cordova, California 95670 • fax (916) 875-8513 <br />Environmental Compliance (916) 875-8550 • Environmental Health (916) 875-8440 <br />www saccountv.eov • emd saccountv.eov <br />15 <br />