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i • <br /> (4 SNOHOMISH <br /> ,. HEALTH DISTRICT <br /> -� W W W.SNOHD.ORG Commissary Agreement <br /> I verify the information provided in this agreement is accurate and we are responsible to comply with the Washington <br /> State Food Code(WAC246-215)and will allow access for inspection during business hours for either business. <br /> Commissary name: The Grape & Grain <br /> Commissary address: 6502 Evergreen Way, Suite A <br /> Business hours: 11 am - 9pm <br /> Commissary owner's name: James Eric Brown <br /> Commissary phone: 425-374-2719 <br /> James Eric Brown 08/02/2021 <br /> Printed name of commissary owner Signature of mmissary owner Date <br /> James Eric Brown 08/02/2021 <br /> Printed name of mobile food unit owner Signature of obile food unit owner Date <br /> ***Washington State Retail Food Code Requirement(WAC246-215-09126.4):The PERSON IN CHARGE shall <br /> document presence at the COMMISSARY on a log, maintain records for one year, and shall make the records available <br /> for inspection by the REGULATORY AUTHORITY upon request.*** <br /> I,the mobile food unit operator, acknowledge that I will be required to maintain logs detailing when I visit my commissary, <br /> how often, and for how long. I will maintain these logs for a minimum of 1 year and will keep the documents readily <br /> available for inspection at the commissary.JEB [initial] <br /> I,the mobile food unit operator,acknowledge that the commissary logs may only be filled out and stored at my approved <br /> commissary kitchen. Commissary logs will not be filled out and kept onboard the mobile food unit. JEB [initial] <br /> s <br /> ,, a. (5.7 A p n r)rirtj v, 0 _ L:.., <br /> Environental Healthi Di m vision Date: I L . <br /> 3020 Rucker Avenue,Suite 104'■ Everett, WA.98201 900■f x:� `�` /63 .5254 III tel:425.339..5250 'Page 2 <br /> g1 DISTRICT <br /> _,�c.z,...� _ tea :` '_ . _ „ . 4. . <br />