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REHS number <br />Date <br />Ap <br />en'J <br />Qe’ <br />de <br />— <br />Out of County REIIS Sign . >ue <br />11080 White Ro<* Road. Sie 200 • Ranctio Cordova CalHonva 05670 • fax (916)875-8513 <br />Environment! Compliance (016) 875-8550 • Environmental Health (916) 875-8440 <br />gitaijiaawWtY.nsl • eind.aaecountv.net <br />Environmental Management <br />Department <br />Jennea Monasterio, Director <br />A <br />m <br />If the proposed facility is located outside of Sacramento County, the local Environmental Health <br />Department shall verify that the commissary and/or commercial kitchen has a current health permit by <br />signing below. The establishment is in C o <? ■ i C County/City. <br />An RIHS signature verities that the facility indicated in above meets CALCODF Section 114294-11429". <br />Phone Number <br />OUT OF COUNTY COMMISSARY <br />NamcofMFF: <br />Name of Commissary: <br />Commissary Address: ^70 <br />Email Address