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VERIFICATION OF VEHICLE COMMISSARY <br /> Please provide all information requested. An incomplete application may delay approval. <br /> /E GSL Fe0 M10 M a� �� � .»��x.� ��., �ti,,r ,� .� <br /> Vehicle Name (DBA): (�05 a CQ S <br /> Address for Vehicle: �O J (AIMMM A <br /> Street Address City <br /> 1) License Plate#: 9U U 2�5 19' 4) Year: I <br /> 2) Vehicle Vin#: I�U TP 32-M X ft 35 GIV55) Make/Model: o M b <br /> 3) State Decal#: (iA 6) Color: <br /> 1 r:aiY.rz.Sa� —'aa�, :, Gig:l[91u1WL:n 'sF� <br /> � /EH1.Cl_ &1)W� f� R IN RR 3 ON <br /> � _..3. 1 �; .k .L.A......c. Y� la:.. ..erSY' `ik.+' ..6vFilOwSt ..." > •.,�3M br .�c�? <br /> Name: 1 0 10 <br /> Address of Owner: ZU4 E. MAW S P0 my 610-n mw6 n q s2 $ <br /> Street Address city <br /> The mobile food facility shall operate out of a commissary and shall report to the commissary at least once each <br /> operating day for cleaning and servicing (CalCode sections 114295 & 114297). If the use of the commissary is <br /> discontinued, the permit holder must notify this office to make the necessary changes. Failure to notify this <br /> office may result in permit revocation and penalties. <br /> i nature of V hicle O for Date <br /> +=F. <br /> '^ F' c%"fse ��1 , 9 L7 P"t�4t,.0 ru 4v+'�' + 'Z t '•�Yvi r ,sem �;r hysr'�r.,'^:,� i�}wv : <br /> �O�VIfNISSA TIFO.RN TION' a fi <br /> <� x x..r_1r_:�Cc�.t•'�4�4s .. <br /> Business Name: MUMMA Wirfaq T VW N KH <br /> Owner Name: solyfflr Pvtflrosm <br /> Site Address: im s, (mi'tortilm jr Mok f Qrj 0 Igo <br /> Street Address city <br /> Phone: ( ) <br /> I, the commissary owner, can and will provide the necessary facilities for the above mentioned vehicle at my <br /> commissary as checked below <br /> ZL' Lid 8,solid waste disposal u Utensil washing sink ❑ Store frozen food Vehicle wash facilities <br /> ( or 3 compartments) <br /> Preparation of food �ot&cold water for cleaning et&hand washing El store refrigerated food <br /> Store dry food/supplies ovide potable water Overnight parking 0�Adequate electrical outlets <br /> 10 <br /> Si ature of Co missa Owner/Op ator Date <br /> r Y "I U a'k 1�wr`• `� �'I a .F_�,o �y <br /> �_HEA�L�Ti»�D-=P.ARTMENT. • fey.{ , � � <br /> If the commissary/food establishment is outside San Joaquin County, the local health jurisdiction must verify <br /> current health permit by signing below. Commissary/food establishment is in <br /> County. <br /> Signature of County REHS Date <br /> EHD 16-017 5 of 6 MFPU APPLICATION <br /> 7/18/2008 <br />