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VERIIRCA) OF VEE1-211CLE COREVEMSARY Piease provide al/ information requestei sr.k <br />..n incomplete application may delay approval. <br />WHCLE <br />I Vehicle Name (DBA): <br />(Address for Vehicle: <br />St-eat.Addr-s <br />2) <br />1) <br />License Plate #:. <br />State Decal 6) <br />Vehicle Vin it 67' 3,mo..53/.n? <br />5) Year: Year: <br />VEHCLE COITMERAP,FOOMAI <br />Name: <br />Address of Owner: <br />Sireet Address <br />onl.,.-4 6 may 17.--op-utt rmit in pe revocadon and F.2..erraities. <br />cHscontinued, CilS permit hoider MEIS2 n.ctify this office to make the necessary changes. F2i1E5Ve C:4 i:Pfli <br />i3j this r <br />operating; day for SE7e- <br />araing and eririging (CalCode sections 114255 01114.207). if the use of the commisiegy is t <br />The mobile food faciiity shall operate out of a commissary and shall ;woe:: to the commissary at least once each i <br />-,, <br />,...„-------Th <br /> <br />OiLy <br /> <br />.. g .-: <br />5— erator <br />AMv INFOKE11241160::. <br />-0Xfs OCDC G\k <br />l- R. <br />2:0100 . Address <br />Phone: (2CC1) <br />cormgssary <br />owner, can and JIYIIIprovide the necessary facilities for the atove mentioned vei-lole nly com7nissary as checked below: <br />4: <br />/9 _e <br />Make/Model: <br />Color: <br />elonatui.e hide 0 <br />t Business Name: <br />Owner Name: <br />Site Address: <br />Citv <br />r 1 7-1 <br />Vehicle wash faciltes <br />Store refrigerated food <br />Adequate elect-3imi Outlets <br />7. <br />Liquid & solid waste disposal <br />Preparation of food <br />Lj Sprrv food/supplies <br />Utensil washing sink <br />(2 or a courpartlierft) <br />Lot & cold water for cleaning <br />Provide potable water <br />El Store frozen food <br />['Toilet a hand washing <br />2( Overnight parking <br />Signature of Commis rv Owner/Operator <br />,H 7=z1ILTidi bmPARIMENT- Date <br />if its cornmissaryiTood e-stabiishment is outside San joaquin County, the ocall healthjurisdiction must verKli current heaitsri permit by sienlng be?ovv. Con3raisearyifccd esiablishment is in CouF.ity. <br />sionature of County REHS <br />Date - <br />16-01T <br />812008 Safe <br />MFPU APPLICATION i