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SAND 1DAUUIN Environm( It EX,rIVE'1) <br /> OCT 30 2i025 <br /> 1 •�� Ittr)N\11 NIAI.IIEAl.HI <br /> COMMISSARY AGREEMI Irr rtiul stl:tit <br /> Mobile Food Facility o Caterer <br /> Corrlprnta sections f and 2 1:•of Sa <br /> I.To be completed by APPLICANT __ -- <br /> Business Name Des taste Ot India L Plate# 4WG7506 <br /> OwnerlOperatof Flame Gurdial Singh _ <br /> Business fvlaJing Address 1243 Montgomery Ln <br /> CA,Tracy 4 Statr-CA Zip953-,/ Elul Ph 209-998-2258 Alt P-r <br /> I 3tzjtE tt,at the ah�Yv rn forrriabw,is cLir enl.fr LLE?nd corrlc4 td i <br /> tho Lest cf my knowledge anri ag-ea ua �,W:je my appfflved cramm+ssary in ac4ordance vrFth Cal-,fcrrwi Health & <br /> Safety Code ar�3 San Joamon Coienly Envirorirrontat Health Department (EHD) requirements 1.1 the use of the <br /> curnrr'rs5anj is i mcon,Irlued holdet rriu S notify toes EHD Failwre to ncif 6,' lt1i$nfflre may re$Ult in p@'r Ill <br /> re+ru�atlnn and.e.r•althFs <br /> 12. To be completed by COMMISSARY OWNERfOPERATOR <br /> Gommissarti AlameMax's Kilnen LL? FAf# - <br /> Andress 1211 S. 7th Street Bus Pnone 209-338-3663 <br /> crty Modesto Zip95351 owne"(0perateryVilliam Berkowitz <br /> Check all appropriate services provided. <br /> p Wastewater disposal , _ , EZ 3-ccimpartme7r sink ® Electr.cal hook-ups <br /> ® Solid waste dlsposat 0 Fooet preporar<<il ® Toilet and haindwa.shing <br /> F9 Hot&Cola water for cleaning © Store refrigerated loud 0 Potable water <br /> 13 Store dry fcodlsuppltes E1 Ovem,nr-1 parking R 1lehrcie wastj <br /> I Lisette Garcia he: -Tl'r_?hat 01F'rnfL •:) I I f.- rrdeJ is current,true anus <br /> correct to the best of my kntnv a fc�e, and meets lhcl r ra Health F.S•s'• . rnEntS. If the food facility <br /> operator fails to comply with the conditlons (:1 11 r-.�ment, of it ' = rr'ad!fied or cancelled. the <br /> commissary a vner s I notify the EHD rm d :i I, <br /> sign7�b!�—E-o--m--p---- <br /> L�—fit <br /> leted by the ENV aquin HEALTH jurisdiction outside of San Jo Co <br /> the commissary is localeta r County The above food facility meets <br /> commissary requirements in i;al!furrlia Healltl 6. Safety Code. The above checked services are, aaa:lable at tl;e <br /> above commissary Please notify EHD if the status of their aperating permit changes. <br /> ReH f s signature Date 1 V l �iv I "?S- <br /> 1st R 1 I-laze1wh Avenue) Stockton Calllornia 95205 1 T 209 468-3420 l F 209 464-0139 l www sjgov.orglehd <br /> ��25 (DoOD 1 <br />