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SANaJOAQUIN Environmental Health Department ' <br /> COUNTY - <br /> Food <br /> OUNTY • • • Production <br /> 1. Indicate the location where you will <br /> ill st�oAre food and equipment at the endof the day. <br /> Commissary Name\10 `r�r`�k,,�^ th'EK 1 V 1�"'"� L Facility I-D/#:. `VO b (U6 1/�! <br /> Address: ") N 1 b�L r�/`17-E � � �f%�i� �2)U-6 6\v 1 LI a 6I J US <br /> MENU DESCRIPTION <br /> Indicate all the food and beverage items for sale. WHERE WILL THE FOOD BE PREPARED? <br /> COMMISSARY ON-SITE <br /> FOOD ITEM <br /> El 1.41 <br /> � Q ElM <br /> E7 (Z r�S El E9 <br /> 2. List equipment and utensils that will be used. Please be specific on equipment's use and function. <br /> For example: Equipment: Blender Intended use: Make Smoothies <br /> Equipment Intended use during food preparation or catering event <br /> Refrigerator <br /> W 90 Com% CC>N D 1 v\A 1,E+� <br /> AZZA PAA Ptc-s P —Ef'i N R ZZA-S kUT71tA D6neO <br /> V(Z7P-W7-( C V7 lel 7ZlA S <br /> ZZA (alL(N 6 CCOLS 'PEFF L 12( L& C--ft 2_ I ImoUUO�J 606 r-I pf 6 <br /> 1 0Q GI-1 7 Sys P00 bk-i SZU PAGE <br /> L Cou—(Lere-4 <br /> WLE &,&j PW, SAUGE AA ( r a2 <br /> 2of4 <br />