Laserfiche WebLink
VERIFICATION OF VEHICLE COMMISSARY <br /> Please provide all information requested. An incomplete application may delay approval. <br /> VEHICLE INFORMATA. <br /> z p <br /> Vehicle Name (DBA): 9 Cr�cirn <br /> Address for Vehicle: L: , r �' <br /> C�c r <br /> Street Address City <br /> 1) License Plate#: �> 27 0S-E' 4) Year: ?C) <br /> 2) Vehicle Vin#: COG iI� ry � 5) Make/Model: )11.iL-/�r/A <br /> 3) State Decal#: 6) Color: <br /> VEHICLE OWNER,INFORMATIU,J11 `"' - <br /> ;t, -...s.ar.r.-e..s..,.� ..$A�+a'_..a+__.g'-±,-.: __��.E:., _.�++r•:..5t' _-' :;__. --'?.t_'" —..-i;" <br /> Irl- <br /> Name: <br /> Address of Owner: 3q 96 p L LA I ii O C <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 /> Si nature' f Vehicle Operator Date <br /> OMMNFORMAT{ON <br /> Business Name: P I O ::�C c m <br /> Owner Name: S'li i rv-,,7.,r,7 Si ✓V�i K SA I ry r <br /> Site Address: 25 Cl-? G 7'L p <br /> Street Address city <br /> Phone: QC,, C)' <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 /> Liquid&solid waste disposal Utensil washing sink �(�Store frozen food <br /> q p (2 or 3 compartments) Vehicle wash facilities <br /> ❑Preparation of food ❑ Hot&cold water for cleaning -'g Toilet&hand washing Store refrigerated food <br /> Store dry food/supplies ❑Provide potable water Overnight parking Adequate electrical outlets <br /> L1 PICK'N GO TCE CRE,AM <br /> •� �� .� ^�+r 'i o r g-o;. CA : <br />