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> <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> <br />Date <br />FA# <br />10/20/25Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Electrical hook-ups <br />Toilet and handwashing <br />yKj Potable water <br />Vehicle wash <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />SANJOAOUIN <br />COUNTY----- <br />CrccHnej? prop; <br />_________________ <br />■'rFO'-’r* <br />Environmental Health Department <br />to notify this office may result in permit <br />_________ ______ to/^n <br />2: Tr be completed by COMMISSARY OWNER/OPERATPR <br />pineapple WHIPS, LLC Commissary Name. <br />Address 5855 MacArthur Blvd <br />City Oakland Zip 94605 <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />i, Janeen Taplin <br />3-compartment sink <br />Food preparation <br />^4 Store refrigerated food <br />Overnight parking <br />_____, hereby state that the information 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 ownpfstell notify the EHD irrynfidiately. <br />S ignature <br />_______Bus. Phone <br />Owner/Ooerator Janeen Taplin <br />Business Name__ /Jaa/4 Br/ve-5 [Y])^ <br />Owner/Operator Name CTfry/JA ^ACey <br />Business Mailing Address I oyi/t <br />City tArH-lZyp State Zip Bus. Ph. (S/O) Rh. <br />I. UA-yM^- Li 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. Fai <br />revocation and penalties. A / <br />Signature___________________<__/ V C) <br />Lie. Plate # <br /> <br /> <br />The commissary is located in Alameda 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 the status of their operating permit changes. <br />REHS Signature.Date