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Plaaaa Provide all Ir "nation MQUOsted. An Incomplete applic i my delay approval. <br /> H TIM <br /> us" <br /> WIMM <br /> Vehicle Name(DBA). <br /> Addmss fbr Vehlolp. <br /> 1) Ucense Plate Ik <br /> 4) Year <br /> 2) Vehicle Vin <br /> Make/Model: <br /> 3) StatteDecalt- t 6) Color <br /> 7;—�s�11,11 11M <br /> NOW MWAK gi Mii <br /> Name: <br /> 11431D hIn6L-D- <br /> L <br /> Address of Owner <br /> The mobile food facility shOff 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&114294 ff the use of the conunissaly Is <br /> discontinued, the permit holder must notify this office to make the necessary changes. Failure to nottly this <br /> Office,may result In permit revocation and penalties. <br /> rator Date <br /> Business Name. <br /> OwnerName: f <br /> Site Addr6m: <br /> My <br /> Phone: ( ZOV'G /-/61IZ7/ 1:70 6W11 -ht 322 2Z� Z 7W <br /> 1,the commissary owner,can and will provide the necessary facilities for the above mentioned veh I[do at my <br /> com ry as checked below. <br /> 7UqWUId 6 805d Waste&Vosed SH W33MV sink food <br /> n cordpaftwft) <br /> 4 VfC2 W��2 ov 0 wash f6dUfts <br /> wW wasr" <br /> offbod V<Or&oWdwHWfbrdearft T7a hm StDrO lfbod <br /> E pofable water OmnW pw" FL cbfcal ouffet3 <br /> S!gnabze of Com ed Data <br /> ff the COMMIssaryllbod establishment is outside San Joaquin County.the local health pidstilction must ve" <br /> current heafth pomdt by signing below. COmmftsaryfibod establishment is in <br /> County. <br /> I Signature of County REHS Date <br /> EKDIW? Safe MFPUAFF=TI0N <br /> 7AWAN <br />