20090909072349713.pdfCOMMISSARY AGREEMENT T LETTER
Date.-
Food
ate.
Food Section
Snohomish Health District
3020 Rucker Ave., Suite 104
Everett, WA 98201-3900
Commissar), letter for: i`.t "Sty
(Nance of Food Stand Concession oz- Mobile Food Vehicle)
1, m ancjs Gam" JIL26, have an agreement with Lc [monc�_ co -o" _Na2Z3/
(Owner name of commissary) (Owner name of Food Stand/Mobile)
giving itrcz r'a-&r'o and his/her employees the right to use the three -
(Name of Food Stand/Mobile)
compartment sunk, the mop sink, food storage areas and the restrooms at
D'�,aBa Hwv 99 , S f tg r Gdmorx4s, w.g W
—_ (Nance and address of commissary)
Check the items that apply: (Place a 0 in the appropriate box)
❑ I understand that cooing of foods will be performed at the commissary.
I understand that cooling of foods will tape place at the commissary.
Space for cooling is available in the walla -in.
C Storage of food will be at the commissary.
The hours that f allow the commissary to be used are: AA--- ^� �
, These hours are during my normal operating hours.
U These hours are outside nay normal operating hours. l have: provided after hours access.
This agreement begins (o ( I a /09 . T am not responsible for any actions of
(Date) (Naanic of Food Stand/Mobile)
outside of my establishment and may terminate my agreement with GbWondS C4anfrksl kA
t _ (Nance of Food Stand/AUbile) �
for
(Reason for termination ofagreenicnt)
I understand that Snohomish Health District has the right to inspect the caraatnissarja while the
Crarrrrrrissary, is in o1mrcation.
I will notifi7 Snoltomish Health District at such time as the agreement is terminated
Co Assar Late; �- '
} Owner
(Co aasult Agar tattor jiey before sigaairrg any legal docirrrrent)
EXAMPLE
Commissary Leiter (for Food Stand Concessions and Mobile Food Vehicles)
A conz7nissar y letter is a signed letter from the owner of a Snohoinish Health District approved and
perrnzitted fctcilit�giving yotl permission to use that facility to store your product, tivash rend sanitize
utensils, provide approved fresh water supply and dispose of wastewater, as tit)ell as use of restrooins on a
daily basis. A separate letter granting permission to use the restrooms is required if the restrooms etre at
a different location than the commissary.
A commissary letter must be submitted with the Permit application for new Food Stand Concessions
and Mobile Food Vehicles, or in the event of a change of ownership. In addition, owners of Mobile Food
Vehicles must also submit an itinerary for their vehicle. if Your commissary agreement has expired or
changed, then a new commissary I Ater is required.
Example Commissary Letter is on reverse side.
EXAMPLE
Itinerary (for Mobile food Vehicles only)
Date
MOBILE FOOD OPERATION ITINERARY FOR:
Name of Mobile Food Vehicle
License it
Pen -nit #
Commissary
Include all stops, listing the time, place name and address:
TI ME NAME ADDRESS
4�00am — 5:00atn Commissary 3020 Rucker Ave, Everett
5:15am -- 6:30am Alice's Gym
7:45am — 8:15am Fish Market
8:30am — 10:00ain Phil's Tires
10:30am — Return to Commissary
4:30pm — 6:00pm Batting Calve
3389 Hansen Ave, Edmonds
14332 Poplar St, MLT
836 Stevens Way, MLT
343 Oscar Rd, Edmonds
Submit a new ilineraa each time there are changes to any of the information.
I SNOHOMISH
HEALTH
DISTRICT
Rev I12607eah
Environmental Heaith Division
Food Section
3020 Rucker Avenue
Everett, WA 98201
425.339.5250 FAX:425.339.5254