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Date <br />enu°l StocWon. California 952051 T 209 468-34201 F 209 464-0138 | ww.sjgov.o^ehc <br />p«0$4H3Z <br />SAN JOAQUIN <br />------COUNTY— <br />M Electrical hook-ups <br />Toilet and handwashing <br />Potable water <br />JZ Vehicle wash <br />'o' '.nfr?a,ion' havs pra''l't"J •* current, hue end >-. • <br /> J _ <br />____LgALLHiyrisdictionoutsideofSanJoaqdirTCon I <br />commissary is ioCated Jr, <br /> commissary reqU:fefnenl3 In The ab°V0 foOd fadlity 016 ***' <br />a^a commissary. Piea5e no.lfl, FHn h , * S !?^e’ The above checked services are available al the <br />•y -D if the status of their operating permit changes. <br />^EHS Signal <br />1866 E. Ha2enon Av. <br />Environmental Health D <br />‘“'^partmont <br />ET 3-companment sink <br /> Food preparation <br /> Store refrigerated food <br />Overnight parking <br />commrssary owner shall nptfy the E^D Immediately. agreen^e.-t Is modified or cancelled, the <br />Signature zZ <br />. ______Date. <br />l3. Jobe compjetgbyThiE <br />commissary is located In <br /> ro soc/mn 3. <br />r^l Plate 2M3> <br />,iy • XJ f <br />Bus. Ph.jc?- .y^y-ZcZ'-^AIt. Ph,yCC1- k-l 7-3^ 0 7> <br />---->y state that the obovu informaton Is curront, truo and correct to <br />my approved commissary rn accordance with California Health & <br />nn^V7^' "x,unt’/ tnvrmnmnntel Health Department (EWD) requircrr^ntj. tf the use or too Xs ^POrrnH h0Wef "'■US1 nOtity lh0 EHD- F,”uro fo not^th* of?ic® in permit <br /> Date / 6 / Sl<7~ l2-^L2oniElgtedby~~CQ^ MISSA RY OWNER/OPERATOR • ~ H <br />t/WrJ______FA#_____________________ <br /> __ Bus. Phone /^/J/-? 7 2-r/>J', _ <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />Cwnpteta sections 1 and 2. /f your comm/sssr/ is tocated outside of San Joaquin County also <br />H. To be compieted by APPLICANT-' <br />Business Name Di ltd <X-A? <br />Ovmer'OperatorNome ..C t' (it <br />Buwm Mailing Address A | <br />C^^m^Sta^SzToJ^WE <br />"’'1 ^r“ to u"'ta -.....•-» - <— <br />commas a,'£hd) <br />mvccation ana <br />Signature <br />Wsm. 9 J-tff.t/fcfcis L <br />Aodr^9_ -F ,s- / ~ <br />_____,zip_ <br />Chock 0)1 sppropnate sen-ices provided; <br />SS yVssieweter dispcssl <br />£T SoW v.aste disposal <br />Hot & Cold Vi'ater for cleaning <br />U Store dry food/^upplies <br />*'•_/^///A; /'