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r <br /> Please provide all Informet°son recluesi:ed. An incomplete application may delay approlrai. <br /> VU`Sm,$c.'L WFORKATIOV, . <br /> Vehicle Name(DBA): <br /> Address for Vehicle: <br /> Streat Adds City <br /> i 9 <br /> I) License Plate t f�' S- CU a) Year: <br /> '=) Vehicle Vin#: 5) MakelModel: <br /> k J) State Decal rr. / G) Color. <br /> i' <br /> } Name: <br /> Address o 0wrier: S' " <br /> Street Addrass Cinj <br /> r <br /> Thm mobile food facilibj shall operste out of a cornmissalnj and shall repos to the con, enissarj aL least once each ,q <br /> or 'Eing day,ar vieaning and serAcing (CalCade sections 114255 Z114207). If tlae use of 9,ie commiss€y ia ' <br /> i discontinued, czhe permit holder ,,muse n'otifij this office 4o make the necessary Changes. Failiare to notify this <br /> office n,ey reams;in perr.6ie tevoca-dos:and penalff-ies. <br /> Signature of Vehicle Operator Date ; <br /> ' t <br /> } Business dame: G� �...�,���`�'i L� i �=�f�J��C�.:��l�,•n t <br /> Name. <br /> Site Address: 7N (}0 _ K('i Cc N �� :�` C)C� <br /> SrseY Address <br /> RhoneI.- (J/- i <br /> .ire cos missaNr owner,cap arra will provide tl�e necesea v; aeil'oiies jos U•ae above mentioned vehicie a;::n y j <br /> l i <br /> i <br /> commissary as checked bei©w: <br /> ,i <br /> Liquid%solid waste disposal Utensil washing sink{2 or 3 compartments) Store frozen food i Vehicle wash Facilities <br /> { <br /> ❑Preparation of food [i Hoff&cold water for cleaning �Toilet&hand washing i Store refiigerateel;ood <br /> a <br /> ® ' red ; foodlsupplie�� is41c' <br /> tab a water- Overnight packing `' Adequate elecffical outlets <br /> t y 3 <br /> 3 <br /> rte. � - %/ ��—�8' i <br /> Signature of CommissarOwneDate <br /> LrDrn <br /> i is the cornmissary1fk-od establishment is oui•side Sate Joaquin County,tEae local heaRh 3unsdicNon must ve 111 n <br /> i cu;rerA heats-. perceii:tear sgg.sinc,below- u3,mm,issarti/lfood eskablishm-en is s <br /> 4 <br /> Signature of County RENS Date t <br /> EHQ 16-04 i 5 of 6 ftIFPU APPLICATION <br /> r-narzoo6 - <br />