Laserfiche WebLink
Environmental Health Department <br />>• I <br />Lie. Plate #9ULC782 <br />Date <br />Date <br />Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <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 /> Electrical hook-ups <br />El Toilet and handwashing <br />Potable water <br />El Vehicle wash <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />_____________________FA# <br />_________Bus. Phone 209-338-3663 <br />Owner/Qperator William Berkowitz <br />------------------- <br />I 3. To fe completed by the ENV HEALTH jurisdiction outside of San Joaq <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 />REHS Siqnature 7^) > 2 <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 />SAN JOAQUIN <br />------COUNTY------ <br />T'Otness grows here. <br />!0 A/p-jt <br /> 3-compartment sink <br /> Food preparation <br /> Store refrigerated food <br />El Overnight parking <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 />2. To be completed by COMMISSARY OWNER/0PERATOR <br />Commissary Name Max's Kitchen LLC <br />Address 1211 S. 7th Street <br />City Modesto zip 95351 <br />Check all appropriate services provided: <br /> Wastewater disposal <br />0 Solid waste disposal <br />El Hot & Cold water for cleaning <br /> Store dry food/supplies <br />I Mark Luis Cruz <br />Business Name Kitchen By Mehfil SFO <br />Owner/Operator Name^a^nam Singh Bal <br />Business Mailing Address 128 N Garfield Ave <br />City Manteca State CA Zip 95336 Bus Ph 2510-677-2300 A|t ph <br />*•—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 and penaltifi^.j <br />Sign atu re______\