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REQIVED <br /> VERIFICATO®N OF VEHOCLE COMPAoftARY DEC [ 9 2016 <br /> Plesse pmulde all trtfomration guested An inooroplet&eppGealion May delay appmusi <br /> EA'l/IROA'AIENTAL H <br /> �G €�Il�� �btt'vilf�l� rT/gERVICE$�TM <br /> Vehicle Name(Dw: <br /> Rddr8a8 FQF Vehicle PA66MM <br /> _ I ai(t f� S <br /> QII <br /> /A�s 9g' 4) Year /H <br /> 2) Vehicle Vin 4: 5` n Z_. 5) Nlakelmodel: <br /> E <br /> ) State-Dgoai Ik6) Color. <br /> r'�%�l•@1�6�'�r �Fi��91=•66�'6t��d06ti :: .:. -:_.. ;..; . _:. . c%.: <br /> i Name: - <br /> � Address cP Own r. S 1 <br /> t bYteetnddeass �-� r <br /> i City x <br /> i "T.9 nohiie tbod faculty almil onerate a'*ate <br /> ooaeranissary and shalt repeat to ). ootns> r arE i�sY or caeaclz <br /> I eisoonng day for clr�aniag 'lnt�aeNit a�g (C3lGnds s®oFftms 44 is 9'd423 if fire use cE the ssanl is <br /> I disc©aatlntsead,BVaa ptta�tlB l5aldee Breus@ t.oBify Buis ofFaC0 to make the necessaalr e <br /> oM,a&avy raeuit in perwr't eevacaeion and Penalties. FMu a to nov7 j Cain <br /> i 'nn.�er� d /. <br /> n re of Vehicle 0 otor Data <br /> Business Name: i <br /> j own®rNatna. u'9. 1�,. 1f1•c �'_�t��f1�-1-',�lc—l.�� <br /> l Site Address. 2q <br /> i Sta2etAddran n ill^ a'Pf•A CT1 ��/ <br /> Phone:(ZCCa) &1(0� bt 5l() i <br /> I,Me eentrrhasary owner,ban and MR provide thenecessacvT sactTities forthe above naPtrttroaaad vehicle at airy <br /> I carnrtaINST as checked below <br /> i <br /> '4 liquid t staid waste disposT tltetrsif washing sink Q St Tefltc feed vehicle wash bobs <br /> i8orsammpaeuname2 0 se <br /> ❑Prewrationortbad 11 omewdwatertbrelwift ®T0wahMdWashhtq I�] Storera6�gerafedfoAd <br /> F <br /> ❑Stnr roodlsupplies Provide potable water ®Overnight partdng ]'� Adaquata aiaabie d'oets <br /> 1 l <br /> � Ja -aCy- i✓ i € <br /> SfgnetureofCommise OwneNO erator p� <br /> T the comrtaisearylfaca estabiishaaaeat is outside Sart Joaquin Couedy,the local helah,(iaelsdiotton must va-My l <br /> current health l3waftbyslgringbelow- eorrrwasawRoodestebashmentisIn <br /> >�o:an5y. - <br /> 7 <br /> Signature of County REHS Date <br /> io�s•oti sore <br /> [ef20Ue WPUAPPUCAMON <br />