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<br /> r's" SNOHOMISH
<br /> i HEALTH DISTRICT
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<br /> ---4--,.--- WWW.SNOHD.ORG - Commissary Agreement
<br /> ii I own both the business requiring and the business providing commissary services.
<br /> El This agreement between the commissary owner and the vendor signifies that both parties agree to the vendors
<br /> access to and use of the services identified below. Snohomish Health District(SHD)will not recognize any transfer of
<br /> this agreement to food service facilities or persons not specifically identified in this agreement
<br /> Mobile Food Unit(MFU) requiring commissary support to qualify for a permit to operate. . . .. .. ... ...... . .... ......
<br /> Name of MFU:
<br /> Owner of MFU:
<br /> Mailing address:
<br /> Phone number(s):
<br /> Email address: i
<br /> Business days&hours: , , .
<br /> - . .
<br /> The following services will be provided by the commissary:
<br /> Approved water supply(If yes, attach
<br /> 11 Yes U No Handwashing sink = Yes CI No
<br /> water bill to application)
<br /> Approved waste water disposal (If yes,
<br /> i Yes CI No Food preparation sink for vegetables CI Yes C3 No
<br /> -attach sewer-bill-to application) .
<br /> Garbage disposal il Yes U No Food preparation sink for raw meats U Yes 1:3 No
<br /> Dry storage for food and single service ill Yes 0 No Approved 3-compartment sink ll Yes CI No
<br /> Refrigeration space 11 cubic feet al Yes U No Approved restroom il Yes ,U No
<br /> Freezer space 7 cubic feet ill Yes DI No Entrance key for after-hours access iii Yes 1:3 No
<br /> Ice in pounds per day 50 lbs. Il Yes CI No Power Supply I Yes U No
<br /> Commissary sewage system II Sewer bill or availability letter attached
<br /> Commissary water system I Water bill or availability letter attached
<br /> Is this facility connected to a septic
<br /> CI Yes il No
<br /> system?
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<br /> district or building department?
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<br /> 3020 Rucker Avenue,Suite 104 NI Everett, WA 98201-3900 il fjicriP26. 'g9.5254 IN tel:425.339.5250 ' P a g e 1
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