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Please provide alt information requested. An incomplete application may delay approval. <br /> 'ehicle Name(DBA): <br /> Adress for Vehicle: J f!v 5 f o C f o n G Cd <br /> Street Address City Zip Code <br /> 1) License Plate#: 5 J S % 4). Year: <br /> 2) Vehicle Vin#: p h1 Z h 2�� ?�n G 5) Make/Model: �- <br /> 3) State Decal#: q 6) Color: <br /> !ame: L- y rr E. <br /> .ddress of Owner: yT �•f c t Tom C o . <br /> Street Address Cit, yip Code <br /> he above-mentioned vehicle shall operate out of a commissary and shall report to the commissar,y, at least <br /> mce each operating day for cleaning and servicing [CURFFL 114265 & 114287]. If the use of the <br /> )mmissary is discontinued, the permit holder must notify this office to make the necessary changes. <br /> ailure to notify this office could result in permit revocation and penalties. <br /> slam_ ;a 1302 - e,oJS <br /> lure pf 'cle O rator Date <br /> usiness Name: ? G6 <br /> weer Name: <br /> ite Address: G . �( S f- L / <br /> Street Addreu City lip Code <br /> lone: 3 V- , t- <br /> the commissary owner,can and will provide the necessary facilities for the above mentioned vehicle at <br /> y commissary as checked below: <br /> Liquid&Solid waste disposal ❑ Utensil washing sink ❑Store Fmun Food Erprovide ice <br /> (2 or 3 oomprrtmeob) <br /> Preparation ufFood12Electrical Hook-up �Toilet&Hand washing Vehicle Wash Facilities <br /> ASmre Dry Pood/Su Iia Provide potable water [yOveruight Parking ❑Store Refrigerated Food <br /> tore o C 'minis O er/O erator Date <br /> 'the commissary/Food establishment is outside San Joaquin County,the local health jurisdiction shall <br /> orify current health permit by signing below. Food establishmenticommissary is in <br /> County. <br /> i tune of County E.H.S. Date <br /> MD 16-01-013 Page 8 of 8 <br /> /12/2007 MFF APPLICATION <br />