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' VERM`V�!}=S]MM OF VE HflCL VOUlltlMUSMW <br /> please pQavide all=u�fo�ai ion request �n incomplete appllea:ior�May delay agaprsval. <br /> �lfr�b &CL-ho 0Rjbq h$CS I <br /> Vehicle Name(DBA): lJ <br /> Address for Vehicle: <br /> - st�2tAddr2ss � , �ibj <br /> t <br /> j <br /> 'i) License Plate t: �! �� �9 ✓� - Q) Year: N <br /> i =) Vehicle Vince. <br /> 3) State Decei#: C 6) Colas: <br /> Nape: <br /> Address orf'Owner. <br /> street Address 1 pity <br /> F <br /> �i zc rsaoioile Er�v 'facil's��+f shaiii OF o�sL ae a cochnmissanf•and shall rapoEt to the com, rMsearif at leas'+0 . eay;ti <br /> 7(�v�rstiri� day for mieaning and servicgn@ (Calc®de sertions M-295& 11420€). i'fGze use e.the ccslnai�ey s <br /> i diSeontirnued, the pemrit holder Must °a.0WIf this Gfyfla@ to maalm ii'd@ Rece'e'S'agry €.'h`c1Y4g'@S. Fatbluve i`3 i2S <br /> office r3say?esuit it •e�ii re�Jo>Gr2'dar,arid,,fo enalt-i . <br /> Signature of Vehicle O-eratvr Date <br /> CON <br /> f Business Name: k i 0A a_n- ;- N 0 i <br /> s Owner Name. _�"� �� `'� 1� � �'` ~t�rr'���`�� _1( <br /> i Site Address: (}� 1�(��c (l� ll Atli 0C,%,, on <br /> k Street Address ��� city <br /> Phone: (Zo-A) t!(.0 q- l� <br /> 1 <br /> s,the cornmissanr owner,can, and wile provide the necessanf?acilitles acr thie above Meritlaned vehicle e r�3y <br /> 3 cE56F'1••'g5uaF1P as chernked below: <br /> is <br /> Liquid&solid waste disposal '� Utensil?mashing sink o El Store frozen food �E Vehicle wash facilities <br /> (2 or 3 compadments) P <br /> i ? � <br /> i <br /> Prepararion of food Hot&cold water for cleaning Toilet hand washing I Store refrigerated food <br /> Sto dry fvodlsupplies 'f Provide potable water Overnight parking �'.� Adequate electrical outlets `. <br /> s Signature ofCog Owner101�erai>7r Dale <br /> a <br /> E ii the ccrrmissarvrlmad es i�lish;eaera�is€ ut'side San Joaquin Country,the local heair�a��risdicti®>r�Must vee��3 <br /> s <br /> Curren; health pen-nit y s3c�ni�; 3®ia�nr. vommisselli ood establis€mere is In <br /> G vi3ntif. ' <br /> 3 <br /> 3 <br /> S <br /> Signature e, Coun4f REHS Date <br /> EHE 16-017 5 Of 6 NTPU APPLIGPCi 10N <br /> 7118(2008 ,� <br />