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� & �� � <br /> ��K� ��AQ� U� Environmental Health Department <br /> & ' <br /> —COUNTY— <br /> ,!Z,6,Ar- Greatness <br /> §xmm's her*. � <br /> [��\<�\ |FORNiA ��--`��~°''~' <br /> � CATERING TRUCK WASH <br /> 008 <br /> �~�~�����U���� �� ���� �����o������������ ST{]C --� ~�''`'"^/ <br /> COMMISSARY AGREEMENT »T[}N'O4852U8 <br /> Mobile Food Facility + Caterer <br /> Complete sections Yand 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> 0 A09006 MANN <br /> Business Name Lin. P|ate <br /> Owner/Operator Name <br /> Business Mailing Address <br /> Citv Stockton State CA Zip 95203 Bus. Ph. 925 503 8194 —Alt. Ph. <br /> I,- , hereby state that the above information is current,true and correct to <br /> the best of M5( <br /> ,*%wledge and agree to utilize my approved commissary in accordance with California Health & <br /> Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br /> commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and penalties. <br /> Signature ��4;W Date 8/23/22 <br /> Commissary Name <br /> AddBus. Phone <br /> City___3tockton Zip 95203 OwnerlOperatorRivera <br /> Check all appropriate services provided: <br /> Ea Wastewater disposal 173~corDp@d[O8nisink U Electrical hook-ups <br /> ff Solid waste disposal 17Food preparation [2Toilet and handvvaShiog <br /> 9 Hot & Cold water for cleaning U Store refrigerated food 17Potable water <br /> 0 Store dry food/supplies UOvernight parking 17Vehicle wash <br /> |' . hereby state that the information | have provided iscurrent,true and <br /> correct to the best of my knowledge,and meets the California Health&Safety Code requirements. If the food facility <br /> operator falls to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> commissaryh <br /> The commissary iulocated in County. 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 EHDifthe status uftheir operating permit changes. <br /> Signature Date <br /> 18H8EHazelton Avenue | Stockton, California 05205 | T 209468'34201 F 209 464-0138 | vmww. jQovu,Q/ehd <br />