Laserfiche WebLink
VERUMQ%u MOW OF t%EIf' MLE COv��NISS URY <br /> Please provide all informaUon requested. 1.\n incomplete application may delay approoraL <br /> TIP <br /> Vehicle Name(DBA): <br /> r Address for Vehicle: �f'�� � � �saLor N <br /> i Stroot Address city is <br /> I <br /> !) LicensePlate 0: %; rp <br /> d 4) Year: <br /> 2) Vehicle vin#: /6 /Z)O UU#Ja.�3`' �y�% 5) Make/Model: <br /> I <br /> s 3) State Decal-,6-1: „� G) Color: <br /> H5 <br /> d�-e �p�pp� n)`pg ygpp �y�r 1 <br /> :5�EC�i5d E O�.i'S�l�ER-:OMFO1>OLI9'S:i<'ION - 1 - <br /> i Name: <br /> Address of Owner: <br /> g Streat Address Cifij <br /> s <br /> c i he mobile food facililij shall operate out of a commaissar~y and shall rapm to the cos,missery at least once each, <br /> operating day for cleaning and servicing (CalCode sections 1.4:295 8, s 44297). if the use of the commissany is <br /> t <br /> discontinued, the Permit holder must notify 'r-his online to make the necessary changes. Failure to no5ify this <br /> cif`ioe may result in pe mix revocation andenaNi les. <br /> 4 <br /> Signature of Vehicle Operator Date i <br /> vel ii€1fd6��c P IMFORMA`-1014 <br /> Business Name: <br /> Owner Name: C.�,1 <br /> 4 ,-Tt C <br /> Site Address: V, C!es". a' o ' t Ue <br /> i <br /> Street Address city r <br /> Phone: (Z(A) L-:1(OLA- V� 5 I O <br /> 1,the ccammissen�owner,call and will provide the necessary} ac@lines foe die above mentioned vehicle ae my � <br /> i commissary as GhecZmd heiaw: <br /> 'Q Utensil washing a Liquid solid waste disposal O g sink ❑Store frozen food Vehicle wash facilities <br /> (2 ora compartments) <br /> t ❑ Preparation of food Hot&cold water for cleaning Toilet&hand washingIQ Store refrigerated food <br /> 'I ❑St a dry food/supplies Provide potable water Overnight parking ?' Adequate electrical outlets <br /> E <br /> E i <br /> Signature o.Com issa Owner/O eratoi Date <br /> k 'lrffII-),i i H DEPART-MEW <br /> ly the commissary/food establishment is outside San.Joaquin County,the local health jurisdiction must verify <br /> s current health permit by signing below- Coraiinissarr/food establishment is:n <br /> Coun4-r,/. <br /> a <br /> i <br /> Signature of Countf REHS Date <br /> EHD 16-017 5 of 6 MFPU APPLICATION <br /> 7118(2008 <br />