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SAN JOAQUIN Environmental Health Department <br />Lie. Plate# <br />1&JDate <br />Sl-SkSDate <br />■REHS Signature Date <br />-------County. The above food facility meets the <br />The above checked services are available at the <br />Business Name <br />Owner/Operator Name <br />Business Mailing Address 8^3 & <br />City -STOCKTOM <br />1868 E. Hazelton Avenue ; Stockton. California 9*305 i T 2C9 468-3420: F 209 464-0138 ; www.sigov.oro/enti <br />ooT^H <br />/ 2 J~ <br /> Wl <br />Commissary Name_ <br />Address <br />City_ <br />_______________FA#______________ ______ <br />______ Bus. Phone_ <br />Owner/Operator <<7^ <br />reasr_______ <br />-yeeb ________ <br />TREftSoSE ftvg- <br />StateCft Zip Bus. Ph. ZO? - /g?7 Ait Ph. <br />th^beTt^G^iy kno^X^aTd agree to utinze^mv^o^*6 T ab°Ve information is current-tnje and correct to <br />Signature <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />Comp/ete sections , anp 2. ^our c^missa ,-s )oeated 01tf^e <br />................................................................. ■■- -iT-. ~ <br />/Z/'. <br />Zip ^S-z-v^ <br />Check all appropriate services provided: <br />H^astewater disposal O^sGompartment sink Okilectncal hook-ups' <br />^Joiid waste disposal (g>00d preparation <br />OTHot & Cold water for cleaning j^Store refrigerated food aTPo^ble water <br />®F<ore dry food/supplies Overnight parking ^K^hicie wash <br /> <br />Signature <br /> <br /> <br />The commissary is located in <br />commissary requirements in California Health & Safety Code <br />above commissary. Please notify EHD if the status of their operating permit changes.