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VERIFIVION OF RESTROO CILITY <br /> se provide all information re9 ues <br /> VEHICLE INI'ORIVIATION <br /> Vehicle Name(DBA): i- (�F�� 0 S M C <br /> Address for Vehicle: '?SC) C A ot-ZD� <br /> Street Address City Zip <br /> 1) License Plate#: L�p(A t3`Z 4) Year: <br /> 2) Vehicle Vin#: IG,611 P32t�5F332�2�y 5) Make/Model: <br /> 3) State Decal#: 6) Color: C�Lt'�Ci�� C1C�LD <br /> WMCLE,OWNER INI+ORMATION, <br /> Name: >r:�M � C,oNzLEZ <br /> Address of Owner: AK �; 30� MCAaotq CAq 20 1 <br /> Street Address City Zip <br /> Mobile food facilities shall be operated within 200 feet of approved and readily available toilet and hand <br /> washing facilities. This is to ensure restroom facilities are available to employees whenever the mobile <br /> food facility is stopped to conduct business (CalCode section 114315). <br /> I have access to the restroom facilities at the following business during my business hours and I am <br /> parked less than 200 f et aw y from the restroom facilities. I will be responsible for maintaining the <br /> restro min a clea a sa ry condition. <br /> - <br /> Si atur f Vehivfe Orerhor ' Date <br /> RESTROOM INTORNIATION f <br /> Business Name: S N o til 60 L 1 CSO 1 OQ STp f_1= <br /> Owner Name: V► e sf t 2a I <br /> Site Address: -7d`7 E �A-Pc(Zc LE( CA g5ZO-7 <br /> Street Address City Zip <br /> Phone: (2 ) ql!�-( /c S2 <br /> I, the business owner/operator, can and will provide the necessary restroom facilities for the operators of <br /> the above-mentioned vehicle at my business and I understand that the restroom facilities are subject to <br /> Environmental Health Department inspection. <br /> 16 �/4� 7 <br /> �// <br /> Signature Business owner/Ope or Date <br /> RECEIVED <br /> JAN 31 2020 <br /> ENVIRONMENTAL HEALTH <br /> PERMIT/SERVICES <br /> EHD 16-013 Page 9 of 9 MFF APPLICATION <br /> 8/17/2007 <br />