Laserfiche WebLink
Environmental Health Department <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />Lie. Plate# <br />Osang <br />Date <br />2. To be completed by COMMISSARY OWNER/QPERATQR <br />Stockton Community Kitchen <br />95206 Owner/Operator <br />J. Vehicle wash ' <br />6 -Date <br />DateREHS Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Cold water for cleaning <br />Store dry food/supplies <br />Saul Sanchez <br />U Electrical hook-ups <br />d^Toilet and handwashing <br />Cjf'Potable water <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 />City Stockton Zip <br />Check all appropriate services provided: <br />□'Wastewater disposal Sf^-compartment sink <br />Q/Solid waste disposal S^Food preparation <br />iS^HoL^ Cold water for cleaning L^'Store refrigerated food <br /> <br />night parking <br />I, Saul Sanchez_______________________, 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 ownerj>hall notifyjpe EHD immediately. <br />Signature <br />COMMISSARY AGREEMENT <br />Mobile Food Facility 4- Caterer <br />SANJOAQUIN <br />------COUNTY------- <br />Greomess -.erp. <br />Commissary Name <br />Address 110 N El Dorado St <br />1. To be completed by APPLICANT <br />Business Name OpTOvV p <br />Owner/OperatorName HQC 1 <br />Business Mailing Address ^54 UCvEtZ- <br />City SToCF-TovJ stated Zip Bus. Ph. '7^\ ytyifoTl Alt. Ph. <br />I, VMvSwX i hereby state that the above information is current, true and correct to <br />the best ormy 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 penalties:----- , . . <br /> Signatur^g=<g^O Date <br />______________FA#_________ <br />Bus. Phone 209-949-2104 <br />Saul Sanchez