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SANS MUIN Environmental Health Department <br /> --.,..r, Greau�u gia„i Aare. <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility• Caterer <br /> Cc+rtvreta s*aV= r u,xI2 M yow corw*55407 la bCehd OUMOs Of San.bsgrrM Cann ry arvo ca7plarr sedlan 3. <br /> . To be completed t3 APPLI <br /> Business tame Travc:in Ljc.pqte*61784M <br /> ownerroperwor Name Joe 9 <br /> Business Maasinp Address PO Box 1371 <br /> UY Rlpan Stat®Ci4 Zip 95M Sus_Ph.(209)452-7108 ph. <br /> I !hereby state thm the above inllarmstlon is CUMK ,true end CofrW to <br /> the best of mir knowledge and agree to utlttte MW approved oomffdssery in soowdom*WWI CaMbrnis Heaft 3 <br /> SWW Code.iend San Jcsquin County Envlfonmental Health Dspadment(END)r,equirerrrants. Of the use of the <br /> carnrnlnafy Is dtsoonunued,the poft holder must notify the EHO, Fetluro to notify thts office m"result in pelmet <br /> rs uon and <br /> lat WIZ <br /> �2. To b comp!M by CQMMISSAF Y OWN <br /> Commissary Name Max's Kdchen LLC FAX <br /> Address 1211 S. 7th Street taus Pi;one 209-338-M3 <br /> City Modesto Z,p 95351 ownertOperatcx William Beftwitz <br /> Check all appropriate services provided: GDrrtr.`s5"^! c1x5 not 1�O�t oVdrN"Erd` 51-brFw(�. Ott Foaa �� <br /> r �- � St4tecl Dr, !-ri Ube C�1 I� 0{' t'1'13� GOeryr+i�CCtA�. <br /> 0 Wastewater disposal ® 3-compartment sink to Et,eetrical hook-ups <br /> 0 Solid waste disposal © Food preparation 0 Todet and handwash.ing <br /> 0 Hot&Cold water for clearing 13 Stone refrigerated food d Potable water <br /> 13 Store dry foodisupplies m OvemIght parking 0 Vehicle wash <br /> I Mark Luis Cfta _ ,hereby OU"that the information I have provided is current,true and <br /> carreotlo the best of my knowledge,end meets the Cefifomis Health&Safety Cade requ,rements. If the food fadfity <br /> (Vembr fob to corrWlly with the ow&tions of this agreement, or 0 this agmenwt Is modified or cancelled, the <br /> corrunissary owner nobly Boa EHD innedistely. <br /> signatur° Date 2S^ <br /> I To be cam feted b the ENV HEALTH jurisdiction outside of San Joaquin Co. <br /> The commissary is located in S�31t6 County. The ;jbove food fa e <br /> ets the <br /> Cr3mrrussary Mquirernents in Callornta Hearth & Safety Coot, The above cht3cked services are availableavm <br /> at the <br /> above comrnissafy_ least:notify EHD if the status of their ope,ating permit changes.y <br /> REHS Signature Date <br /> 1868 E. Hazehon Avenue I Stockton,Callfbmla 952051 T 209 469,342,01 F 209 464-0138 1 www_sygov.orglehd <br />