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Environmental Management `�u� <br /> Department h � {ri <br /> Marie Woodin, Director a <br /> OUT OF COUNTY COMMISSARY <br /> Name of MFF: SS 0N��e!!Pi/aG1S <br /> Name of Commissary: #X MA-AIA <br /> Commissary Address: lg r F PFs cA.I) AUr- # IDI %RACY M- O13Py <br /> If the proposed facility is located outside of Sacramento County,the local Environmental Health <br /> Department shall verify that the commissary and/or commercial kitchen has a current health permit by <br /> signing below. The establishment is in Sc--r.S O oSq vA �n County/City. <br /> An REHS signature verifies that the facility indicated in above meets CALCODE Section 114294-114297. <br /> \Co.c��o.r�ne L:r� hrnre5 --�L(e) q3 <br /> Out of County REHS Name(Please Print) REHS number <br /> 2 2 <br /> Out of County REHS Signature Date <br /> 20C\- b I b- 3 25 1C� � f\Ihm.resR sjgp\.) 00 <br /> Phone Number Email Address <br /> P 2 c:) S `•1_"I S <br /> 11080 While Rock Rd.,Ste.200 • Rancho Cordova,CA 95670 • fax(916)875-8513 <br /> Environmental Compliance(916)875-8550 • Environmental Heallh(916)875-8440 <br /> www.saccountvmet,.cmd.saccoumv.net <br />