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SAN-JAQUIN <br />--COUNTY— <br />Environmental Health Department <br />1. Indicate the location where you will store food and equipment at the end of the day. <br />Commissary Name: 4L � 13Y-rz5c`5 CColi-inU� <br />Address: r-1'-15 Weer <br />Facility ID a: FA Oo0';451 <br />MENU DESCRIPTION <br />Indicate all the food and beverage Items for sale. <br />WHERE WILL THE FOOD BE PREPARED? <br />FOOD ITEM <br />C M ISSARy <br />ON-SITE <br />�BIriS' C.l�IL1<GN13��( �p1�-� <br />Cvvlc [ I li Ckc/v 13EcP pc2� <br />❑ <br />CIIItA5= OTIA-ro sc kZA , mnmyani sedan Gt-tr 5d, <br />0 <br />❑ <br />fw/L) C�r�eE"' ��i�N lMac 4 c��r�sf b�r.�ced hca.vrs <br />% { Zeno{ Ine•reoh-Pj-4-S <br />❑ <br />�o�a s wry-��tzS S�IceS <br />El <br />Ia <br />(PG �S <br />❑ <br />❑ <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 <br />Intended use during food preparation or catering event <br />Refrigerator <br />hL p Fa2ro1 [610( <br />5'TDVC <br />VGCV( <br />`[3 B Q Plf <br />Cvvlc [ I li Ckc/v 13EcP pc2� <br />Cambry tV«>7,tc1t <br />1Z8,1 , FPOW A467 <br />Car+bro P06I0r <br />keno Idd 1aeoI`.5 <br />blerickr <br />% { Zeno{ Ine•reoh-Pj-4-S <br />LvTTINGt goctrplS <br />`fo ev"� �neli �Ln� �/e rl-e—�rl�e5 <br />Tn S jox �KN r�E <br />�O TLIl� /Y'L/fi T Ap, Al C v <br />(PG �S <br />-16 Cook Vey 441-,s <br />2 of <br />