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VERIFICATION OF VEHICLE COMMISSARY <br /> Please provide all 'information r equestod. An incomplete application may delay approval.. <br /> 7___(QUA : � _Heirhicle: q - -- <br /> troet Address F. <br /> n <br /> 3 <br /> 1) License Plate#: `f) Year: <br /> 2) Vehicle Vin#: /G. y�e c� �Y 5} Make/Model: <br /> 3) State Decal#: 6) Color: <br /> 4' <br /> rr9r5 J'\' 11me ,��� 'fyy '" �j .rts^-, r'✓'`1TyY� , ^Tt�^'-'.SFS l 5: "",,""..�^ -r- ---.»t <br /> INN sks -t,.,",ik" '++'` q� �' ,r�' _ia <br /> gess of Owner: <br /> Street Address <br /> city <br /> t mobile food facility shah operate out or a commissary and shall report to the crsmrniasary at least once eac:3 <br /> Crating day for cleaning and servicing (Calt,.ode sections 1`94299 & 1'14297). !R the use of the com"Missary is <br /> :ontinued, the permit holder must noti4, Flus Office to make the necessary charges. Failure to notify this <br /> ce may result in permit revocation and penalties. <br /> Q of VehicleoZ O l <br /> �a�tpurl;uratar 5 Q <br /> � rT7� r p'.._...._-. <br /> !. � 4 .� 3'�.*�" F3V `?'y��'•..n....r `i..i��'r..�.,�F..S�'..�i.-+r..ter S <br /> iness Name: <br /> - — � <br /> ler Name.- <br /> Address: ��ail <br /> Street Address -- ---1 <br /> City <br /> -- <br /> a commissary owner, can and will provid <br /> missary as checked below: e tle aleaessar}c(abilities for tie a ,ave mentioned vehicle at my <br /> iquid &solid waste disposal ❑ Utensil washing sink <br /> (2 or 3 compartments) ❑Store frozen food �j Vehicle wash facilities <br /> reparation of food ` Hot&cold water for cleaning Toilet&hand washing ❑ Store refrigerated food <br /> ;ore dry food/supplies I EProvide potable water vemight parking <br /> `Adequate electrical gullets <br /> iture of CommissarC)wNn:r erator Rate <br /> h` I W01N <br /> commissary/food establishment is outride Marc �i gain County,the 1pcs health jurisdiction must verity Y'f <br /> nt health permit by signing below. Commiss .7,f1food establi ,',.ment is in <br /> ty <br /> ture of County REHS pate <br /> � 5 of 6 <br /> MFPU APPLICATION <br />