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Environmental Health Department <br />REHS SiQfWthjra. <br />18&a E Hazelton Avorop I StocMcn, Cabtomm 95205 | T 209 <58-34201 F 209 4M-0t3e | w*w cqt«M <br />■EHclectntal hoofc-upi <br />CTToi’ei and hancU-ashlno <br />■O’T’aabfo water <br />erfatwio wash <br />. SANJOAOUIN <br />L. - - i Ol IUTY- - <br />... j- s >fiu • • ; •• ■ 1 <' • <br />CT'.3- ownpartme rvi tinfc <br />ETTood preparation <br />CT*Store refrigerated too# <br />■CT Ort/rnght parking <br />____, twreby state INit^WWmrktoftf hew jxcnMwjtB current, tnw Mid <br />correct to the best ot my krowtedpe, and meet* the Cafifcmia Hcefth & Safety Code fequwcrwnts. tt the food toefity <br />cperatoc taSa to wtth the condfijorw of We agreenwii or tf thia ogreemem is rrwxMed or ctrceled. the <br />commtiisry owner shi9 <br />BjprwlMm. ............. _____^Dnae. <br />1'3, Tube complgtedby the ENVHEALTH of^Sah Jba^l^nCo. <br />The oemmissaty & socateG in_______ _ _____ _ , tomr. The atorc food taittty mocta trw <br />oowrUBsaty requirements in CallforW Hcafth & Safety Code, liie above dwdted swvicea ate avaSsWe al the <br />above oothmMsary. PSaaww needy EHO U the ilahii cf thoir operating pcmhil chnngea. <br /> hpXUJ__ <br />C-'^) OtivrZKnk' h<k<jv <br />COMMISSARY AGREEMENT «^g|^^ t14 <br />Mobile Food Facility ♦ Calorer <br />GefttoWrt r a.'*J 2 rtytWf wYiur vMwy ;a k-cefotf OAiCv’sto at .$.■»>•> Jc-aqtsr Cvue?/ eteetetfna 3 <br /> <br />i' iTTo be ^ , ' "" —— ------- j <br />Businoiw_____________Uc RsteM <4 LV& "7 £>9^ <br />O^nedDperaior Namu yzxrryiH “t -^- S * *? H____________ <br />Bu^nsss Mailmg Addrfes.5.J4 b¥ ^BeCZyrnAD U^CkM _ _ _______________ <br /> c^.MeyOtX__statofllfrap ntp?t__________ tjfecrhik. ____ . I- tioiTf uta Jr: tr.m ma BtxA'e t’lfpmutajri is ouneet mn* «hd CKrfTtCt to <br />fbo bee! .a my «ncwe<ig*rt-k7 euree to u!i_r<» my ^{zt vcC ccrr.rrrtsjtry «•- aowtUrcow Cal/ecnia HeaW> 4 <br />Safely Code rmd Sah Jm€^5 CowMy tnv^ynnmVil iionsri [kpartmen’ (EHO) fvtptwwt*. if 5»r inw tf the <br />oxiWs^My is rftwwinuec ’.he fwrrt ?«tfder tmnt not^ tno FHD FdMro to nnJIfy Ihta offee my fw.fl in permit <br />revocation ar*! penates <br />SQnafura_ ......................... ........ pnr#__ <br />j 2. To be qompteted by COMMISSARY O\^ER^F^RATOR~^“" <br />Ccmm^mfy NttnwiX^JyU <410^ TX<4t> <br /> <br /> <br />kSlT-Oty. Bas PltoAe f'Z^ fn^^- <br />Cdy/Tu, Y/c>CZS>- Zfo OwnwfOowatof <br />-------AjlOr* <br />zip---------------< <br />Chock all apptajwra** services provided: <br />Ef^Wastewater drs^oM i <br />(B^SoW waste dtspeskl <br />ETHot & Cold water for dcanmg <br />ET'Stoco dry food'nrpotias <br />tlyenA I 7*^10