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I <br />Environmental Health Department<» <br />M f3 S ILie. Plate # <br />; and m^ts the California Health & Safety Code requirements <br />Date. <br />SAN JOAOUIN <br />------COUNTY------ <br />Greatness grows <br />Electrical hook-ups <br />X Toilet and handwashing <br />X Potable water <br />Vehicle wash <br />I have provided is current, true and <br />if the food facility <br />or cancelled, the <br />COMMISSARY AGREEMENT <br />Mobile Food Facility $ Caterer <br />Comp/ete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section^ <br /> 11, To be completed by APPLICANT <br /> <br /> <br />2^^ <br />REHS Signature <br />,3SB E. Haielion Avenue I ,=203, T 209 ASS-3420 | F 2004.4.0A3S |«0«.ora»» <br />^Wastewater disposal <br />Solid waste disposal <br />cEtHot & Cold water for cleaning <br /> Store dry food/supplies <br />|, j(\ VcCc Y'CC- WLa. s----- <br />correct to the best of my knowledge, <br />operator fails to comply with the conditions of this agreement, or <br />commissary owner shall notif^ihe EHD immediately. <br />S ignature/,/-------------------------------- “ _____________ _ <br />FTT^Tb^itedTTlhrENVHEAiZE^^ <br />'' County. The above food facility meets the <br />The commissary is located in Noa|th p safetv Code ThTabove checked services are available at the <br /> _______Date____________________________ <br /> \r cl m <br /> -Zip <br />Check all appropriate services provided: <br />I3x3-compartment sink <br /> Food preparation <br /> Store refrigerated food <br />X Overnight parking <br />. hereby state that the information <br />if this agreement is modified <br />Business Name <br />Owner/Operator Name -----M ------------- <br />Business Mailing Address—2 ------£-------L t <-< _____ —- ~ <br /> City StateO Zip^ 5_2OS_Bus. Ph-------------------------------Alt. Ph. -------------- <br />" IL \ i -rr^x l+eot-oVL hereby state that the above information is current, true and correct to <br />revocation and penalties. 2-.— 20 - 2.0 VA//P' Date y -—— <br />S ig n atu re._____--------------------------------------------------" “ ____ ______ <br />------------------------- -----------1 <br />Commissary Name Lex—( u ^€<0 Ca <-----F - <br />■ -bub.vw- J)-- <br />_Owner/Operator Gi. L*------C ^\^-—--------til- <br />City.