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File ii <br /> goLaNO <br /> Department of Resource Management <br /> 675 Texas Street,Ste.5500 c 2 bq s <br /> Fairfield,CA•94533 <br /> o www.solanecounty.com <br /> OV Nt <br /> Environmental Health Division Iagjinder Sahota,REHS , <br /> (707)784-6765 Environmental Health Manager <br /> COMMISSARY AGREEMENT <br /> *Completion of this <br /> s-Coommissary Agreement is required prior to issuance of Solano County Permit of a Food Facility. <br /> Vehicle/Business Name: 1"N K� . COU3 opt, IWTS Lj_C <br /> Commissary Name: ',,C SRA- $t-,P^G 'n <br /> r Z 1 \ �� L e 'c k <br /> Commissary Address: 21V& ONu tm PI4VAv 11/07, '+ Kkv CA V 3W moi-/ter/ <br /> Commissary Owner's Name: p"J- Mtn]-� Telephone: 2C:n-7g49 q q7 <br /> Type of Facility: ❑ Market 5KRestaurant ❑ Warehouse ❑ Other: <br /> I, the commissary owner/operator, agree to provide the necessary facilities for the above mentioned vehicle at my <br /> permitted facility as checked below: <br /> [V(Food preparation k4tensil washing [/rRefrig./frozen food storage <br /> [L?fotable water supply [910I y food storage [t]'Supply/equipment storage [ <br /> ]Food product supplier N Liquid waste disposal [ ]Electrical hook-up <br /> [U4estrooms [ ]Vehicle/cart storage [64'Garbage disposal <br /> I agree to notify Solano County Environmental Health of any change in the status of my operation or when this <br /> commissary agreement is no longer valid. A copy of the current health permit is provided. <br /> Commissary Owner/Manager Date <br /> E.H.DEPARTMENT AUTHORIZATION(REQUIRED) <br /> The following information shall be completed by the local E.H. Department if the food establishment/commissary is <br /> located outside Solana County: <br /> The food establishment/commissary is located in S g`Y —j C7y\a lnln County. <br /> The above establishment is in good standing with the local E.H. Department?_YES NO(explain below): <br /> Out of County RENS: rmdL'y\hotre5 �czl.9a r ,� _ 2 —AU " 2 Z <br /> Print Name Signature Date <br /> I certify that,to the best of my knowledge,the above information is true and that I will comply with all applicable local, <br /> city, county,and state requirements. <br /> Vehicle/Business Operator: <br /> Print Name Signature Date <br /> 4 <br /> S <br />