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COMPLIANCE INFO
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EHD Program Facility Records by Street Name
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1717
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1600 - Food Program
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PR0544107
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COMPLIANCE INFO
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Last modified
10/21/2020 3:44:28 PM
Creation date
5/7/2020 4:19:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0544107
PE
1633
FACILITY_ID
FA0025089
FACILITY_NAME
DOGOS GOURMET EL SEBAS #4MH8965
STREET_NUMBER
1717
Direction
S
STREET_NAME
UNION
STREET_TYPE
ST
City
STOCKTON
Zip
95206
APN
16904012
CURRENT_STATUS
02
SITE_LOCATION
1717 S UNION ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
JCastaneda
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EHD - Public
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VERIFICATION OF VEHICLE COMMISSARY <br /> Please provide all information requested. An incomplete application may delay approval. <br /> VEHICLE INFORMATION <br /> Vehicle Name (DBA): h1CCL�('01'\l/-t C ff S <br /> Address for Vehicle: j 2_ f_'<_C_ ;Imo' t% �- !l 7l STSG Crt� ` 5�e~'- <br /> Street Address City <br /> 1) License Plate t `f/fin H {}(S- 4) Year: <br /> 2) Vehicle Vin#: 5) Make/Model: t�(2L/) <br /> 3) State Decal #: 6) Color: G.L.!/-/ (-I— kc-1) <br /> VEHICLE OWNER INFORMATION <br /> Name: <br /> Address of Owner: <br /> Street Address City <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 <br /> discontinued, the permit holder must notify this office to make the necessary changes. Failure to notify this <br /> office may result in permit revocation and penalties. <br /> 113 <br /> S' nature of V 'brator Date <br /> COMMISSARY INFORMATION <br /> Business Name: U C, t, L J - 1/�L, ck " lv�i`C <br /> Owner Name: J /�` : /-, / 'p () <br /> Site Address: -? , <br /> F r; <br /> Street Address City <br /> Phone: ( ) 5' ._ <br /> I, the commissary owner, can and will provide the necessary facilities for the above mentioned vehicle at my <br /> commissary as checked below: <br /> FJ <br /> oj:d &solid waste disposal Utensil washing sink Store frozen food FIVehicle wash facilities <br /> (2 or 3 compartments) <br /> o'`ood a riot&cold water for cleaning ©toilet&hand washing L Store refrigerated food <br /> _ - __ _ _•ores rovide potable water 2Overnight parking Adequate electrical outlets <br /> ell <br /> SicnaLre - ssaa Owner/Operator Date <br /> HEALTH DEPARTMENT <br /> If the commissaryMood establishment is outside San Joaquin County, the local health jurisdiction must verify <br /> current health permit by signing below. Commissarylfood establishment is in <br /> County. <br /> Signature of County RENS Date <br /> EHD 16-017 5 of 6 MFPU APPLICATION <br /> 7/18/2008 <br />
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