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Environmental Health Department <br />n <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />1. To be completed by APPLICANT <br />Talofa Island Treats NALie. Plate#Business Name <br />209-345-1119 Alt Ph. <br />DateSignature. <br />FA# FA0001271 <br />Bus. Phone 209-914-7966 <br />Owner /Operater Reulilyn Pangaliman and Lilibeth Gampon <br />Date REHS Signature. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Commissary Name Quickly Manteca <br />Address 502 E Yosemite Ave <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />SAN JOAQUIN <br />-----COUNTY------- <br />Owner/Operator Name__ <br />Business Mailing Address <br />City Turlock state C£ip Bus. Ph, <br />I Alefosio Laumoli i 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. Failure to notify this office may result in permit <br />revocation andl penalties. ( <br />Date <br />2. To be completed by COMMISSARY OWNER/OPERATOR_________________ <br /> Wastewater disposal <br /> Solid waste disposal <br />EJ Hot & Cold water for cleaning <br />EJ Store dry food/supplies <br />I, Reulilyn Pannaliman <br />Electrical hook-ups <br /> Toilet and handwashing <br />0 Potable water <br /> Vehicle wash <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 owner shall notify the EHD immediately. <br />Signature <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in 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 />Date 10/02/2025 <br />City Manteca Zip 95336 <br />Check all appropriate services provided: <br /> 3-compartment sink <br /> Food preparation <br />13 Store refrigerated food <br />’ Overnight parking <br />Alefosio Laumoli <br />942 Gettysburg St <br />C^ip 95382