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c <br />de3 / <br />City Phone: (209 ) 464-4570 <br />facilities for the above mentioned vehicle at my <br />I, the commissary owner, can and will provide the necessary <br />commissary as checked below: <br />Date Signature of County REHS <br />Signature of of Vehicle Operator Date <br />COMMISSARY INFORMATION <br />Business Name: La Comercial Corporation <br />Owner Name: <br />2900 E. Harding Way, Stockton, CA 95205 <br />Street Address <br />Site Address: <br />pi Store frozen food Ki Vehicle wash facilities <br />E Toilet & hand washing D Store refrigerated food <br />II Overnight parking n Adequate electrical outlets <br />!XI Liquid & solid waste disposal <br />7 Preparation of food <br />Fl Stor d,r food/supplies <br />1X1 Utensil washing sink (2 or 3 compartments) <br />Hot & cold water for cleaning <br />Provide potable water <br />Signature of Commissary Owner/0 <br />HEALTH DEPARTMENT <br />If the the <br />commissary/food establishment is outside San Joaquin County, the local health jurisdiction must verify <br />current health permit by signing below. Commissary/food establishment is in County. <br />/ <br />Date <br />G. R. "Chip" Arnett, Jr. <br />RECEIVED <br />VERIFICATION OF VEHJçIE COMMISSARYAN <br />2 2 2018 Please provide all information requested. An incomplete application may delay 4pproval. <br />EN <br />Address for Vehicle: ;7 7 I ag 9V-43-- Street Address <br />VEHICLE INFORMATION TePli <br />Vehicle Name (DBA): <br />ORONMEN TAI ftt KMIT/SERWCES <br />License Plate #: p e/ J 4) Year:. <br />Vehicle Vin #: d ov x 1150 Igo 5) Make/Model: <br />State Decal #: 314, 6) Color <br />VEHICLE OWNER INFORMATION <br />Name: ail/C-11A- 4,LIA, -CA, a7n/MdC_ Address of Owner: //y ektd.e.,,w age: ,lb-,44k.,,pir gs. -,,, y O 7 Street Address <br />City <br />The <br />The mobile food facility shall operate out of a commissary and shall report to the commissary at least once each <br />operating day for cleaning and servicing (CalCode sections 114295 & 114297). If the use of the commissary is .discontinued, the permit_ 1,:je" er must notify this office to make the necessary changes. Failure to notify this office may result i cation and penalties. <br />EHD 16-017 <br />7/18/2008 5 of 6 <br />MFPU APPUCATION