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SAN JOAQUIN Environmental Health Department <br />Lie. Plate <br />z <br />-3 <br />Date REHS Signature. <br />1868 E. Hazelton Avenue | Stockton, California 952051 I 209 468-3420 \ F 209 464-0138 \w\v\v.s\gov.ovglehd <br />iu et »> BdK <br />111 <br />3 = •: <br />r <br />1 <br />J <br />1 <br />1 <br />S’ ? <br />= 3 <br />X ? - <br />i $ <br />/z i 1 <br />|| 1 <br />5 | <br />- i <br />FA#_______________________ <br />___W6/4/^^______ <br />o 'nHe <br />•£ - <br />- <br />1 K «■% <br />3-compartment sink <br /> Food preparation <br /> Store refrigerated food <br />® Overnight parking <br />---------' hereky ,stlate th^the information \ have provided is current, true and <br />4 . x ........~ 7 - -__je requirements. \f the food facititv <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified or canceiied the <br />ifyjh$ EHD/immediately,. <br />42/4^44 ________Pate. <br />3. To be completed by the ENV HEALTH jurisdiction outside oJ San~Joa^nCo?\ <br />The commissary is located in County. The above food fac\tity meets the <br />commissary requirements in California Health & Safety Code. The above checked services are avaitabte at the <br />above commissary. Please notify EHD if the status of their operating permit changes. <br />2 - M I iniyi2 - " C- o S ’S S J j ? ■; b “ | <br />g? ? - 5 <br />- ■? 2 <br />3 4 3 7 - . - <br />J = 11 2 7 k <br />IL 'JMR ri <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />'pTTTllTT " r°'‘r r°mmiss°r>'15 i-ctw Of s,„ Jo„„„in c„„„,z O|SQ ari„^ 3 <br />n. I ° be completed by APPLICANT <br /> <br /> <br /> " ••• ~pf — <br />-OjO; Rj‘ «...------------ <br />Signature^ / Z?^ C^VT <br />------------ ' ---------------- -----------------------Date__ <br />Z: To kTc9mpllted_by COMMISSARY WNEWOPERAfpp- <br />Commissary Name, 4o^)CC^ f: C ^//n <br /> <br />C''y---------------------------------Zip OwnerlOnemtn, <br />Check all appropriate services provided: <br />^3 Wastewater disposal <br />S Solid waste disposal <br />Hot & Cold water for cleaning <br /> Store dry food/supplies <br />L- A'/f-Q 4^_____ <br />correct to toe best of my knowledge, and meets the California Health & Safety Cod< <br />commissary owner shall notil <br />S i g natu re_________4^44 <br />Eiectricai hook-ups <br />Toiiet and handwashing <br />Potable water <br />^Vehicle wash