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I-Jj <br />« <br />I <br />9 <br />immediately. <br />Date <br />REHS Signatui <br />zET 3-compartment sink <br />ET Food preparation <br />O' Store refrigerated food <br />Overnight parking <br />eTElectrical hook-ups <br />ETToilet and handwashing <br />Potable water <br />Cf Vehicle wash <br />commissary owner shall noth <br />Signature <br />Ma G<j <br /> > _ 1 - <br />xs <br />'H./ro ■ <br />C <br />yihb?- <br />% <br />w <br />OUvc^zR's''llL"Il'':* <br />-’7, <br />145 S Kilroy Rd <br />TurWk. CA <’53SO <br />20>634^000 <br />Environmental Health Department <br />Bus. Phone L <br />Owner/Operator_ 4rr25^ <br />[3. To be completed by the ENVKEOtUyris^^ <br />in n l S I fl Lc S County. The above food facility meets the <br />lomXX^e^iirements in California Health & Safety Code. The above checked services are available at the <br />above commissary. Please notify EHD^f the status of their operating permit changes. <br /> D2 <br />•, ? * *- * <br />SAN JOAQUIN <br />—t COUNTY----- <br />1 <jreolnffj\ grew* hcrt <br />COMMISSARY AGREEMENT - <br />Mobile Food Facility ♦ Caterer <br /> <br />- ' ] <br />11. To be completed by APPLICANT— <br />/1J 'T' 1' in. I'lmc/i <br />Business NamC-jr/f/Z/’^z?^___LQ^-TJ I/r y ‘ -------- <br />Owner/Operator Name Ma/TQ___Ma ‘ 1 \ OtHD <br />Business Mailing Address ° — ~ City State eZZp2^42_Bus. Ph.jC^lW-^1L-h ——— <br />the best of my knowleSe and ag^TtoT^ze my aPP^ Dartmcnt (EHD) requirements, if the use of the <br />Safety Code, and San Joaquin County Environmental Health D f d 1 (jf (his office may result in permit <br />commissary is discontinued, the permit holder must notify the EHD. Failure to nomy <br />revocation and penalties. / <9 - iZ/TJvZ? <br />Signature <br /> 2,-lo bZcoEgeldby CO Yf.-.iSSARY OWNER/OPERATOR <br /> Commissary Name ' Address^ Bus. Pbonel^--------- <br />City Tu V I D Ct. . „Zip <br />Check all appropriate services provided: <br />Q^Wastewater disposal <br />CT Solid waste disposal <br />EfHot & Cold water for cleaning <br />Ef Store dry food/supplies n Overnight parking u <br />,-TLvvlG TV .hereby state that the information I have provided is current, true and <br /> 3- _ <br />Date. <br />fi^ws^iy? <br />186fl E. HazeltonXenue^Vtockton, California 95205 | T 209 468-3420 | F 209 464-0138 IwTON.sigov.org/ehd <br />\ <br />h T <br />T..A