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VERMC ATEON OF VEHOCLE C0MMOSSARY <br /> plea provide all information requesiied. ?fin incor�p>eiie apptiea�i0 May delsy spprevsa. <br /> LE R <br /> 11lT�t?0t. €l9rJ�e:x�.�6� <br /> y <br /> Vehicle(dame(DBA): � <br /> ? Address for Vehicle: <br /> atre2l Address city t <br /> {( s <br /> t � <br /> 4) Year: AOC g <br /> r •i} Lioense Plate�: ��L1 � 3 <br /> r) Vehicle Vint,: yI19 qt9 fit �jJ.SG'y� GS-) Malce/Model: IV1 <br /> State Decal : C 6) Color: ,�i`�C`;12�. ✓ <br /> i <br /> € ``•:`�l'��@Eat ���fli9�t�-��9��k� �_6��_. _ - _ _ <br /> 5 name: l/f�"� Cvt--t,.A <br /> Address o;Owner: <br /> Street Address Cihj E <br /> lac-m013119foad faciiiV Shall operate out C rir a Can-n, issenr and shall Pepoittc the comwdeGas�r at 1eas� <br /> cpelsiirta <br /> day fir diearaisi�j and�eriricin� ��al�ccie seGtlo as 934205 8i114207). io�Gze les€o:he oo mis�ny is <br /> ; disc©caLlccied, the Seca ie ti®ldee 0s> notlfy Tis Of�Liee Lc inalee slae neoesssry changes. r-ailure'4 n0��j��is r <br /> 2 iT€fid:i�ay?esug in ^e ii �v�J Gr21-or @n ena1; �. <br /> Date <br /> Sfgnsture of Vehicle Operasos <br /> �-0mQI3,smP-XRkIr-0 RURRAT if6 <br /> Business Name �.. , nom; ` a <br /> g Owner E\lane Lr—, l4 ' �t C A E <br /> Site Address: 1a G I� .�c�,i Cli�r '� �y <br /> suae4 Aadrzss ci€y <br /> Rhone: (Z0,A) lI l�,��1�- � l <br /> ! <br /> I i,she cemissarvr owner,can and vui2ii above se00ne6 veiaicoe <br /> Corl2mi issaT. as checked beitow: y <br /> S <br /> Utensil JrJashing sink Store frozen food Vehicle wash facilities <br /> -'_ Liquid c solid waste disposal ��or 3 comraf�errs) ° <br /> a <br /> Preparation of food !; Hot&cold kjater for cleaning Toilet a.hand%-Lashing Q Store refrigerated food <br /> FI <br /> St o dry foodlsupplies i:_ Provide potable °pater ovemight parking Adequate electrical outlets <br /> Signature ofCommissary OwnerlOperato ©ate <br /> ERA <br /> r , <br /> s if l:Ie corrr�issanyflood estaulisi,nent is outside San Joaquin Count j,&be 30001 h0ai•21,IM$sdiodon m�asi:veg~r f ti <br /> i <br /> Current i�eai4f:pe-a3st bys'sgning below. vo�raissar�tlfeod esrai�1is13�ec�as'saa <br /> Signature of Countf REHS Date <br /> EHD 10-01T 5 Of 6 MFPU APPLICATfOi,! <br /> T118(2008 <br />