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SAN ,10AQUIN Environmental Health Department <br /> _...COUNTY— <br /> Greatne;. q.rn: <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility + Caterer <br /> Complete sections 1 and 2. if your commissary is located outside of San Joaquin County also complete section 3. <br /> 1 . To be completed by APPLICANT <br /> Business Name Kenstan Farms DBA Wedge Holtow Farms (Ad Partner) Llc. P[ate#IN 3625421 <br /> Owner/Operator Name Sarah Preston (AdminMuthorized Agent); Garrick Smith (Operator) <br /> Business Mailing Address 1053 Commerce Blvd <br /> City Pelham State AL Zip 35124 Bus. Ph.256-404-1415 Alt. Ph. <br /> I Sarah Preston hereby state that the above information is current,true and correct to <br /> the best of my knowledge 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 an penaltie . <br /> Signature 11 Date 12119/2a25 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <br /> Commissary Name Fraternal order of Eagles FA#NIA <br /> Address 217 E hockeford St Bus. Phone 209-570-6695 <br /> City Lodi Zip 95240 Owner/Operator Nick Traxler-Trustee <br /> Check all appropriate services provided: <br /> p Wastewater disposal 0 3-compartment sink 13 Electrical hook-ups <br /> p Solid waste disposal E3 Food preparation ® Toilet and handwashing <br /> 0 Hot & Cold water for cleaning 0 Store refrigerated food D Potable water <br /> D Store dry food/supplies G�Overnight parking 13 Vehicle wash <br /> I Nick Traxler , hereby state that the information I have provided is current, true and <br /> correct to the best of my knowledge, and meets the California Health &Safety Code requirements. If the food facility <br /> operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> commissary owner shall notify the EHD immediately. <br /> Signature :ms�. � Date 12/19/2025 <br /> 3. 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 /> commissary requirements in California Health & Safety Code. The above checked services are available at the <br /> above commissary. Please notify EHD if the status of their operating permit changes. <br /> REHS Signature Date <br /> 1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> M25C3'A i?' <br />