Laserfiche WebLink
Please provide ail information requested. An incomplete application may delay approval <br /> [Address <br /> EHICLE INFORMATION <br /> hicle Name (DBA): �` 7AC � Cc) <br /> for Vehicle: OVZ,10 <br /> Sddr <br /> Street Aess� ' Lj City <br /> 1) License Plate#: e,9 SO A 63 4) Year: Mj <br /> 2) Vehicle Vin#: ��a�HhS� I�Ok13SUic�by 5) Make/Model: /✓C <br /> 3) State Decal#: 6) COIOr: <br /> VEHICLE OWNER INFORMATION <br /> Name: ',A <br /> Address of Owner. <br /> Street Address City <br /> The mobile food facility shell 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 & 1142971. 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 /> 11 .. P f` / I1 - IO -2020 <br /> SI naturd of Vehicle Operator Date <br /> OOMMI SARY INFORMATION <br /> Business Name: or e 1.a e-f- I r1 silo ) <br /> Owner Name: SG ���\L/ 2,UeA.- C — h <br /> Site Address: Z Y ' C} j. / 1 r o e t,j r- I C14-6P 1 <br /> 2 G� <br /> Street Address City; <br /> k Phone: (ZC� � � ._ t � i <br /> I 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—T(tonsil washmpartme sink Store frozen food Vehicle wash facilities <br /> ,.�/ (2 or 3 compartments) <br /> E? reparation of food u Hot& cold water for cleaning �l Oilet&hand washing Store refrigerated food <br /> 1.EI Store dry food/supplies provide eotabie water D<vemight parking ddequate electrical outlets <br /> !O ZU <br /> S <br /> ignature of Commissa Owner.Operator Date <br /> TH DEPARTMEfITommissary/food establishment is outside San Joaquin County, the local health jurisdiction must verily <br /> t health permit by signing below. Commissary/food establishment is in <br /> Countv. <br /> i <br /> i <br /> Signature of County REHS Date <br /> EHD 16-017 <br /> 7/18/2005 MrPU APPLICATION <br />