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COMPLIANCE INFO_2020
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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1600 - Food Program
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PR0539344
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COMPLIANCE INFO_2020
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Entry Properties
Last modified
12/9/2020 8:37:23 AM
Creation date
11/13/2020 3:25:44 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
COMPLIANCE INFO
FileName_PostFix
2020
RECORD_ID
PR0539344
PE
1635
FACILITY_ID
FA0025198
FACILITY_NAME
LA PALMITA #5X52753 & #6C66585
STREET_NUMBER
2440
Direction
S
STREET_NAME
AIRPORT
STREET_TYPE
WAY
City
STOCKTON
Zip
95206
APN
16913327
CURRENT_STATUS
01
SITE_LOCATION
2440 S AIRPORT WAY
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\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): <br /> Address for Vehicle: <br /> Street Address city <br /> 1) License Plate#: L 10( 4Year: <br /> 2) Vehicle Vin #: C- r, y�'1 j•tv1^j� h� 5Make/Model: (7M L <br /> 3) State Decal#: 6) Color: fia&tG. <br /> VEHICLE OWNER INFORMATION <br /> Name: N� W�6A <br /> Address of Owner: Jj(LA 1Q-),t6teV,\ c n�`✓ T)f f�1S�Ci ii` <br /> street Address city <br /> The mobile food facility shall operate out o.a commissary and shell report to the commissary at least once each <br /> operating day for cleaning and servicing (CalCode sections 9.14295 & 714297). 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 /> off" a ma result in perms:r Vocation ar d penalties. <br /> �i� iAV <br /> Sigma of VeNcle Operator Date <br /> COMMISSARY INFORMATION <br /> Business Name: 6L If f . Lu SU <br /> Owner Name: c- _,f S J <br /> Site Address: 2 o S. r r — 5�0C g hi4 <br /> street Address City <br /> Phone: (Z-ocj) S > ' <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 L; Utensil washing sink Store frozen food dVehicle wash facilities <br /> (2 or 3 compartments) <br /> separation of food �ot&cold water for cleaning ,�Toilet&hand�a•asliing �Stnre refrigerated rood <br /> U Store dry food/supplies Provide potable water ��Overnight parking .[2/Adequate electrical outlets <br /> Signature o Commissary Owner/Operator Date <br /> HEALTH DEPARTMENT _ <br /> If the commissary/food establishment is outside San Joaquin County, the local health.unsd'iction must verify <br /> current health permit by signing below. Commissary/food establishment is in <br /> County. <br /> Signature of County.REHS Date <br /> s <br /> EHD 18-017 50f6 "FPU APPLICATION <br /> 7f 18/2008 -�'" <br />
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