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Environmental Health Department <br />■i <br />_Lic. Plate#53104P1 <br />Date <br />\/ >0(7-^REHS Signature Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | <br />S Electrical hook-ups <br />S Toilet and handwashing <br />0 Potable water <br />E! Vehicle wash <br />______________________FA#_______ <br />Bus. Phone 209-338-3663 <br />Qwner/OperatorWilliam Berkowitz <br />SAN JOAQUIN <br />—-COUNTY------ <br />Srecff.nes? yrows here. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> <br />1. Tobe completedby APPLICANT ~ <br />Business Name Las Ranitas <br />Owner/Operator Name Maria De Rosario Aguilar <br />Business Mailing Address 26909 Dodds Rd <br />City Escalon State CA Zip 95320 Bus Ph (209) 719-0717 A|t ph <br /> <br />thZhoet i------TO---------1------------------ - hereby state that the above information is current, true and correct to <br />Safefe Code LdTj ^reeUtiliZe my aPPr°Ved commissary in accordance with California Health & <br />afety Code, and San Joaquin County Environmental Health Department (EHD) requirements If the use of the <br />revocation^nd Z"' b0'"" EHD' “t0 °ffiCe maV in <br />Signature <br />2. To be completed by COMMISSARY QWNER/OPERATOR <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 />SZi Wastewater disposal '' <br />E2 Solid waste disposal <br />Ei Hot & Cold water for cleaning <br />Cl Store dry food/supplies <br />I Mark Luis Cruz <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 ownpr shall notify the^EHD immediately. <br />Signature, ~ .Date 0(-26-2C <br />3, To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. | <br />The commissary is located in (\)UYvV-|Countv. 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 />^3I 209 468-3420 | f- 209 464-0138 | v/ww.sjgov.org/ehd <br />S’ 3-compartment sink <br /> Food preparation <br /> Store refrigerated food <br />dVernight parking <br />-------, hereby state that the information I have provided is current, true and <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the