Laserfiche WebLink
<br />I ilc H <br />I (Mid I Hdlity ‘ <br />L> <br />• vpc oi l acility I I Market ) Wai chouseI I Hcslauranl <br />I <br />4 <br />■n <br />I I l oot! preparation <br />M Potable vvatei supply <br />I /| I (Kid piodnct supplici <br />[yj Restrooms <br />Out of County REUS: o <br />Print Name <br />| | Re frig / frozen food storage <br />| | Supply /equipment storage <br />[yj Electrical hook-up <br />fy| Garbage disposal <br />Department of Resource Mjiiui^eineiH <br />675 I exas Street, Ste. 5500 <br />l iiiiTicItl, ( A • 94533 <br />www.sohiiiocouniy.coiii <br />I nviionmcntal I leallh I hvision <br />(707) 784-6765 <br />?/7Z/z6 <br />Date <br />commissary A(;ri:i:mi:nt <br />( ''mplctioii (if this ('mninissary Agreement is required prior to issuance of Solano ( minty I’ennit of a <br />I certify that, to the best ofiny knowledge, the above information is true and that I will comply with all applicable local, <br />city, county, and state requirements. <br />■ y,' fe-fc <br />I )ate <br />completed by the local !• II Department if the food establishment / commissary is <br />JX Other <br />I. the commissary ownci/opeialoi. agree Io provide the necessary facilities for the above-mentioned vehicle al my <br />pci milted facility as checked below <br />City. State, Zip Code Lodi c <br />Telephone <br />Com m y <br />Signature <br />l^fl hensil washing <br />| | Div food stoiagc <br />| y| I .iquid waste disposal <br />Vehicle / cart stoiage <br />I agree Io notify Solano ( ounty I nviionmcntal I leallh of any change in the status of my opeiation or when this <br />commissary agreement is no longei valid A copy of the current health permit is provided <br /> <br />( ommissaty Owner/ Manager .- '7 Dale <br />E.U. DEPARTMENT AUTHORIZ ATION (KEQUIREI)) <br />flic following information shall be <br />located outside Solano ('ounty <br />Vehicle / Business Name p-tCOS 7 Ok <br />Commissaiy Name 11 |r)/^5/A^y <br />Commissary Address A/ LjULi id AvC <br /><'ommissary Owner's Name 5 <br />I he food establishment / commissary is located in A ~TC> (’ounty. <br />I he above establishment is in good standing with the local li.ll Department?. <^\'I'S NO (explain below): <br />Vehicle / Business Operator: <br />ITinl Name SSgualubr