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3-compartment sink <br />Food preparation <br />Ki Store refrigerated food <br />gi Overnight parking <br />El Electrical hook-ups <br />al Toilet and handwashing <br />Potable water <br />Ei Vehicle wash <br />, hereby state that the information I have provided is current, true and <br />SAN JOANN <br /> <br />Environmental Health Departmr:rt <br />.:QMMISSARY AGREEMENT <br />od Facility ,‘ Caterer <br />ana 2, if your commissary is located outside of San Joaouin County also complete section 2. <br />z.-omotetea by APPLICANT <br />Name es \ Hog- <br />nrOperator Name \ 5‘ '001 <br /> <br />LIG. Pia te 1"/1/' 2 k V,3 <br /> <br />...:±ss mang Address rz._'y JfLVS Q.1 <br />piihAtca... State. C,-Zip 9531'7 Bus. Ph. 2..99 <br />I. RKSL`J F-(2, SA t-5 G\ . hereby state that the above infgAtign is current. true and correct <br />the best ot my knowledge and agree to utilize my approved commissary in accordance with Californie <br />Safety Code. and San Joaquin County Environmental Health Department (EHD) requirements. It me use OT tn.., <br />..ommissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in nerr,-, <br />revocation and oena <br />Signatu;v, .5-77 20Zti <br /> <br />_2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Food Service & Supply FM <br />Address 2440 S. Airport Way <br />Stockton Zip 95206 <br />77 au i appropriate services provided: <br /> <br />Bus. Phone <br /> <br />Owner/Operator Reyes Rubio <br /> <br />r f Wastewater disposal <br />tif Solid waste disposal <br />ft I :z,t. & Cold water for cleaning <br />"Store dry food/supplies , <br />T e)4,JC-S V/00 0 <br />—,:rrect to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />7.cerator rails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> Date Cl 1 <br />-.7-rrn:ssary owner snail notify the EHD immediately. <br />To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in County. The above food facility meets the <br />rfrnmissary requirements in California Health & Safety Code. The above checked services are available at tn€ <br />'-lboye commissary. Please notify EHD if the status of their operating permit changes. <br />R.EHS Signature Date <br />Hazelton Avenue I Stockton. California 95205 I T 209 468-3420 I F 209 464-0138 I wwv...stoov.oroYld <br />'YZ1Lt oo2a