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SA Al A H n N Environmental Health Department <br /> _--. COUNTY <br /> Food • • • <br /> 1. Indicate the location where you will store food and equipment at the end of the day. <br /> Commissary Name:TWE &-f-ft,4- lam" I l_'UuaGrF Facility ID R: 00 <br /> Address: "Qu 0"VO4 (NE, I fty C{} 0j4--b()4 e \ os 1S <br /> MENU DESCRIPTION <br /> Indicate all the food and beverage items for sale. WHERE WILL THE FOOD BE PREPARED? <br /> FOOD ITEM COMMISSARY ON-SITE <br /> tipm 61f-W tw-� Z� ❑ <br /> S**jVj 6 CL-O4.& (Luo PIR) R1 ❑ <br /> s�R-1C� N €s [r ❑ <br /> sem, �� C7" ❑ <br /> P�srW�-s 4s oEss>;ft� ❑� ❑ <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 Gt;LD fMo serf, <br /> PAr�G� C'00\411(. CpVW-Pp %M tt1q,A5 <br /> t� Rs "96 civ rev rR;tns <br /> W S tivnS W�PP+�A2�tr�1 91f 4RssemptAaG t1' ms <br /> kN1Ft_ 6 S11fiCµc -V1 t)(e4m6 WMPTA"Us /INi&wket 3 <br /> CVoWtab 1p*4m �unuS �PftKs ,(bf�tSliFz tP1nS;14Ry5 too- CADW1 (. <br /> V\je:A VIC32- bw-wv CMDs CAT*-.41& <br /> 2 of <br />