Laserfiche WebLink
Please provide all information requested. An incomplete application may delay approval. <br /> Vehicle Name(DBA): Vr <br /> Address for Vehicle: IA a 'lite <br /> l Street Address S U <br /> I <br /> citys <br /> I U <br /> i) License Plate*: y1'�/� GSD 30 4) Year: <br /> a <br /> ^) Vehicle Vin M l,Z Jel 5) MaicelModel: <br /> 3) State Decai:'L L6 G) Color: <br /> c <br /> I Name: <br /> Address of Owner: <br /> Street Address �i <br /> �` e mobile trod faciliE shall operate out©�a Conk raaissany and shall r2pottt to the corjMissary at least orae each <br /> *a{ae 6tcto day for cieaning and servicing (CalC ade sections 114295 a 194297). lb tete use or`tae con�rraissary 9s <br /> i dimeontinued, "I�ae permit haider stzusk ngOtifiiy this office to males the necessary Changes. Failure to �©4�f1y this it <br /> c3f�toe mal'esuet trd Terni it revoca�or:and peatallriess. <br /> / <br /> Si tyre of Vehi O erator Date <br /> l'-. s �Y F�kblUtl4 <br /> Business Name: <br /> Owner Name: <br /> 1r <br /> Site address. <br /> Su'aet Address <br /> Phone: (ZC�A) Ll(0 LA _ � �i city <br /> 1, he commissary©weer,can artd will provide tine necessaeny?acilities'iW id-ae above mentioned vehicle at t <br /> Gc'S6i missallf as Checked beiQW: nay <br /> 3 <br /> Q Liquid c solid waste disposal Utensil washing sink <br /> (2 or 3 compariments) o Store frozen food Vehicle wash facilities <br /> Preparation of food Hot&cold water for cleaning Toilet&hand washing O Store refrigerated food <br /> z Store dry food/supplies <br /> '' �! <br /> 0 Provide potable water Overnight arkin <br /> 0 9 P 9 ?s Adequate electrical outlets <br /> j <br /> 12' r9 of Commner/0 eraror �� Dale <br /> l; Ie c 0 rn rn 1 s s a n dfeod establishment is Outside San Joaquin County,the local heal•Ul jurisdiction must vetl�f <br /> fcurrent heaith per�'se by signing below. Con missaryleood es��ablish es3t is in <br /> Signature of Countf REHS pate_ <br /> END 1&OIT <br /> 7118t2008 5 0f6 <br /> MFPU APPLtCATfO'N <br />