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CMFO <br /> msu Other <br />Zip Code: <br />cold) <br /> Disapproved <br />Date: <br />zY/N Sewage disposal <br />Y/N Warewashing <br />Garbage <br />>ry food storage <br />FA# <br />PR# <br /> MFF-CatC C____ ___ <br />& CMFO must fill out back <br /> <br />rfft-Z/S/Ziy/Yl <br />if zr^ <br />Date <br />Comments: <br />11080 White Rock Road, Ste. 200 . Rancho Cordova, California 95670 . fax (916) 875-8513 <br />Environmental Compliance (916) 875-8550 . Environmental Health (916) 875-8440 <br /> Market <br />Signature of Commissaw^ Date ~ <br />Commssaiy Approval: □Pending □ Approved <br />Verified by : <br />Environmental Management <br />Department <br />Jenriea Monasterio, Director <br />’vemight parking (^Y/N Toilet & handwashing <br />ilectrical hook-up <br />/ Supplies storage <br />Supply food products <br />as checked for the above-mentioned <br /> Restaurant <br />__ <br />-------- -C»y: ___C^U_ <br />------MFF Access Hours: <br />Y^)o. <br />Y/h" <br />Y0 <br />(Y^ <br /> MFF- Cat D CATERER <br />-----------------: page) _____ <br />j,d r~’ —f----------- <br />x... ^// <br />----------------------------------------------------------------------'' <br />COMMISSARY or MSU VERIFICATION <br />(XTFX1!/f r)r°I) FACILITY (MFF)/ MULTI EVENT VENDORS <br />(AffV)/ CATERER/ COMPACT MOBILE FOOD OPERATOR (CMFO <br />MFF/MEV/CATERER/CMFO BUSINESS INFORMATION: <br />Type of Facility: MEV DMFF-CatA MFF-CatB <br />(Eood^rep^ at commissary) <br />MFF/MEV/Caterer/CMFO Business Name: <br />License Plate Number (if applicable)’ <br />Owner Name: I <br />Owner Mailing Address: _QQ^ I citv- A^I4 n . <br />—SzaTfeiSzzz-yzfxf <br /> —OTir ofthe ielow ntaitimed co <br />commissary is discontinued, I <br />—________ ____ <br />Signature of MFF/MEV/Caterer/CMFO Owner <br />COMMISSARY INFORMATION: <br />Type of Facility: Q. Commissary7 <br />Commissary- Business Name: <br />Commissary Owner’s Name: <br />Commissary'’Address: j/^/ <br />Contact Phone: <br />Y^N/Preparation or packaging of food <br />(Y/N Potable water supply ( [ghot <br />Y (N/Refngeratedi frozen food storage <br />/vy N Cleaning Areas drained to wastewater/sewer system Y <br /> ’H7/" <br />qN <br />I " . .71