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Date iscirteture of County REHS <br />c• <br />Zdi <br />ct, Store frozen food [,Z Utensil ',Nestling sink <br />(2 or 3 oorrmetzeres) <br />16-017 <br />'20013 5 af <br />WiFFURFPLiCATION <br />VERRICATRUN OF VEHICLE comeallemRy PEeese provide atk information requested. An 'incomplete eppketion rney deiey approval'. <br />License Reek 8-73.39.m 4) Year; <br />Vehicie Vin #: ire:i7.4:7,3WX1C:/)//43 ilitakefiviodet <br />Stat Decal t <br />VEMCLg WNERINFTO <br />I Name: _.vuei <br />Address df Own*: 5-7 JAA, <br />&rest Addraim <br />e 6) Color: <br />grk:1-?,A4zie6,-6P:. ' <br />4-1,11-G eiet QcjeS1- 77 City <br />WiEifcLEINFORRIKTE <br />Vehicle Name (DA); <br />I Address. for VehiDis: <br />stem moms <br />Me- mons food faoiDitir ahaii opeTate out of a counntlasary and shan report to the comma:mazy at alasre.onoe ean 1.1 aperffdrig dem far cisaning and serrtafC & 1142071. if time use of the coniraiseary is discontinued, Ste pent hoEdeF must tro52iiij eft Ofire59 to snake the nacessaQr changes. Faihre to notifir this office. n'iglf Few/Alia pennit revocation and pea-raEffes. <br />- — / <br />Date <br />Business Name: <br />-7.Q()(` — - — I t 1---1 a • <br />510 <br />the commissary owner, can end wilt provide the necessaw facilities for the above me <br />Intioned vehioRe at mly commissary as checked below: <br />Liquid & sad waste disposal <br />0 Preparation of fooci 4 D-7-cl Hot & cold water for cleaninc <br />waif to- ad/supplies,/ Provklepotable water <br />0-12-/14-e- , <br />Signature of Corn assary Ovvner/Op(e- <br />HEALTH DEPARTRIERT <br />f the commissary/food estebEisiment Es outside San joaquin County, the local health judscliction <br />ErtEiSt verify —.turrent hesith permit by signing below. Coramisserygood as is hi goi.hrzy. <br />, ,4gnature of V 1de Operator <br />COMOSAktiti06*- <br />Clo,A.r\P_ITCLA '3\k' :srin <br />P(ne.A-3 /4. ,PS" <br />SVeet Address <br />Owner 1\121716-: <br />Site Address: <br />Rhone: (ZCLI) <br />YEIToilet 11 hand watilinr, <br />Overnight parking <br />.1.0 Vehicle wash facilities <br />ri7 <br />j Stara refricerata-d food <br />2 <br />a <br />Adequa-- elect-fora; outle <br />Date