Laserfiche WebLink
VERIMAT90N OF VEHNCLECOMMo33,ARIRECEIVED <br /> Please provide all information requesr�ed, An incomplete applicetlora raay deiay approv@CT 16 2018 <br /> VEHICLE NNFORMATIOt Tti <br /> Vehicle Name(DBA): <br /> Address for Vehicle: <br /> 5frest Address � City <br /> t <br /> �) Ucense Plate* _15 9/ / 4) Year. . '� <br /> 2) Vehicle Vin#: -5) Make/Model: <br /> !� �) State Decal L.-TT 6) Color. <br /> j, VEHICLE ^WLNeR INFORMAMON i <br /> Name. {ee , <br /> Address 6f Owner-A& T <br /> 5treaf Add - <br /> city <br /> disi he mobile food facility shall operate out of a commissary and shall rsjpwy to the�.:.,�,�►miry at i�si once each <br /> i <br /> opEd <br /> ratIn9 day for Giesning and servicing (CalCode sections 114 9 G "9 �9�). !f the use of the commissary is <br /> continued, the permit holder must notify this office to make the raecessanf changes. Failure to notify this <br /> of;ice may suit in permit rev Cation and penalties. <br /> 4 y <br /> I i <br /> Signature®r Vehicle erator Dote � <br /> COMMISSARY NF-ORMATlON <br /> Business Name: La Comerciai Corporation <br /> Owner Name: G_ R. "Chip.Airnett, Jr. <br /> Site Address: y, , <br /> � 29Q0 E. Hardin Wa Stockton CA 95205 <br /> street Address city <br /> i Phone: (2019 )464-4570 <br /> s <br /> i 1,the commissary owner,can and wHi provide the necessary facilities forthe above mentioned vehicle at my <br /> 09mmissarsr as checked below: <br /> t <br /> Liquid&solid waste disposal Utensil washing sink ❑ o <br /> (2 ora compaRments) Store frzen food © Vehicle wash facilities <br /> ❑Pre ration op rood Hot&cold water for cleaning ra Toilet&hand washing ❑ Store refrigerated food <br /> ❑ tore[}ty cdlsuppiiez Provide table water iC Overnight parking g %; Adequate electrical outlets <br /> Signature of Commissa Owner/0 erator ®ate, 1 <br /> HEAL 7f� iD 2PARTIi(i!ENT <br /> i If"who co;rraissatylfood establishment is outside San Joaquin County,the local health jurisdiction must verify <br /> current health permit by signing below. Commissary/food establishment is in I <br /> County. <br /> j Slcgnature of Counter REHS Date <br /> EHo 16-017 �of6 <br /> 711®!2908 MFPU APPUCATION <br />