Laserfiche WebLink
Pcii,VE <br /> VERMCATOUN OF VEHOCLE COMDAO&GARYunEC 2016 'D <br /> PF-Ovide all*YnformaHOn rcques'wd- An inCOMPIOL",applicationmay delay approval. EN.Vlpo <br /> 1�E ?��io :�6iitt - .:- - h JNT9/_HEAL <br /> 7'H <br /> Vshide Name(Deft. <br /> F. <br /> Address for Vehicle: �te,e , <br /> 4L <br /> city <br /> 4) Year <br /> 2) Vehicle Vire#,.- <br /> Mal(emodel: <br /> X i <br /> DeGal <br /> Colon <br /> 74 <br /> Name- <br /> I;Z <br /> Address Wiowner. <br /> 7i <br /> mobfieload feeljiV Shall aperaje out e <br /> =MMssary area Shall report to the Comoftsaw at least, once each <br /> dmy fer c-leaning and;aordting (CMIGPdO Mr-tions;114206 a JjQg?). Iq the uele of the <br /> cc�eat�tissar+�ss <br /> -der must '-202 I NO Offie*W Mice the aecesewj changes. [--Muresko <br /> rioi9iif his <br /> G-4[' MMY Feats-HR Permit revccadOn and permiffes. <br /> W - <br /> 0 J-- J <br /> 8! noure of tfa We 0 erator <br /> Business Name: <br /> Owflar Nam, L%-- r, <br /> Site Address., <br /> CA <br /> qP <br /> ( fteatAddraw <br /> Phone. <br /> (0 LA <br /> �'la CMnlisse0i owner,can and will provide aha necessary fatigues for the above MTO 02ed vehicle ek n,:y <br /> as rheskerj helovr <br /> Liquid L solid waste disp.1 Utensil washing sinkS <br /> C2ar3aampohnaft) 060CIStomfrozen food Vehicle wash fadtfies <br /> ❑Prejoarstlon Of food Hot&cold water for 0108fta 19 Toilet A-hand washing Store refrigerated food <br /> plies Provide po I table water Ovemight paddrig Adequate electrical outlets <br /> oMerl0 e <br /> Date <br /> -7 <br /> X- <br /> H.the Car-ImigearylF006 establishment is ouWde San joagiigin r,011MY,ff's local health jurfeacuon Mustlferw± <br /> Current insaft paraft by S'sqn�below- Can.nilssary1food establishmenj is L-1 <br /> Signature of—countr RENS Date <br /> M 16-017 <br /> WFUAFFLICATIOM <br />