HomeMy WebLinkAbout20260210_PJA26-0097_Commissary Kitchen SNOHOMISH
COUNTY
HEALTH DEPARTMENT Commissary Agreement
f verify the information provided in this agreement is accurate and we are responsible to comply with the Washington
State Food Code(WAC246-215)and will allow access for inspection during business hours for either business.
Commissary name: V 1 i L
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Commissary address: C 1i 5±�� - -5 4
Business hours:
Commissary owner's name:
Commissary phone: '12 — 5G1 - 2.
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ented Name of Commissary Owner Sionaweof Commissary Owner Date
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PHMO Name of Food Service Establishment Owner Sign ood Service Establishment Owner Dat
FOR MOBILE FOOD UNITS
Washington State Retail Food Code Requirement(WAC 246-215-09126.4):The PERSON IN CHARGE shall
document presence at the COMMISSARY on a log, maintain records for one year, and shall make the records available
for inspection by the REGULATORY AUTHORITY upon request.
Please read through the following statements and initial to indicate your agreement:
I,the mobile food unit operator, acknowledge that I will be required to maintain logs detailing when I
visit my commissary, how often, and for how long.
1,the mobile food unit operator, acknowledge that I will maintain the logs for a minimum of 1 year.
1,the mobile food unit operator, acknowledge that the commissary fogs may only be filled out and
stored ON-BOARD the mobile food unit.
Environmental Health Division
3020 Rucker Avenue,Suite 104 ■ Everett,WA 98201-3900 0 fax:425.339.5254 ■teL 425.339.5250
SNOHOMISH
COUNTY4410k
HEALTH DEPARTMENT Servicing Area Agreement
Fill out the following section if you will obtain fresh water or dispose of wastewater at a site other
than your commissary.
Facility name: _ r� /�'/ j'Sc�>t-cc� C��i.�/�Ss%a-x7 ,fir 7C��
Facility location: ` �/ STs 7� Az`� _ S yrVic' f-/ 1dl t j°S�'i��c� Ge;l� `� y76
14'This agreement between the servicing area owner and the vendor signifies that both parties agree to
the access to and use of the services identified below. Snohomish County Health Department will not
recognize any transfer of this agreement to food service facilities or persons not specifically
identified in this agreement.
This section must be completed by the person in charge of the proposed servicing area.
Services provided (select all that apply):
Zf1ciling
" harging liquid waste Elsolid waste disposal
fresh water tanks ❑ vehicle/equipment cleaning
Is the facility connected to a septic system? ❑ Yes �No
Is a grease trap required by sewer district or building department? Yes ❑ No
Servicing Area Sewage system ❑ Sewer bill or availability letter attached
Servicing Area Water system ❑Water bill or availability letter attached
I, the servicing area provider, understand that this mobile food unit will be disposing of wastewater that may
contain fats, oils, and greases. The mobile food unit is allowed to dispose of wastewater using our facilities.
I, the servicing area provider, understand that this mobile food unit will be filling their fresh water tanks
using our facilities. The fresh water is from an approved public water system and the water connection area
will be kept sanitary at all times.
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P ' ted name of servicing area operator n rv' area operator Date
CA 1,�J e,r
Phone Email addres
Disposal. Liquid waste shall be emptied from the retention tank to an approved sewage disposal system
every time the fresh water is filled. Wastewater must be removed so that a public health hazard or nuisance
is not created. Dumping wastewater onto the ground, storm drainage, carwash facility, or other non-
approved sanitary sewage system is not allowed. Written records of disposal (including date, location of
disposal, and quantity emptied) should be maintained onboard for at least 6 months.
Environmental Health Division 8_``a-S
3020 Rucker Avenue, Suite 104 a Everett, WA 98201-3900 0 fox: 425.339.5254 ■ tel: 425.339.5250