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VERIFICATION OF VEHICLE COMMOSSARY <br /> Blease provide all information requested. An incomplete application may delay approval. <br /> 77, <br /> Vehicle(`lame PBA): 1° - <br /> Addressfor Vehicle: A,m7d-Ijk� <br /> 1} License Plate#: qo 9��Z / 4) Yearlqe <br /> 1 2) Velvclevin /6 ; 66) rdakambdei: <br /> 3) Decal ft6) Color. <br /> Jlli�t�s � qp� 71 - . = <br /> .....: :..: : <br /> Vane: .� --- - ' <br /> Address of Owner 1 <br /> str�etadd, GG 4-tCP, 96;q,0 5 <br /> 'he: obtle good faoRlly shall operate out of a UIV <br /> I ID"toting day tar deaning and and 14203 repoBio the commissary at least o each <br /> �at9(�l6®d®seo to 10 91 9r 994294), cff thean case or Sae connaiesary is <br /> disoeaEtnaeoffi,grae ®tonic balder must noYipj phis olRce to mane t€ae necBSgagr changes. F7um to no5fy two <br /> i e nWj s e retrocation and aerrwes. <br /> I i nawre of Vehicle 0 erator <br /> IUdMIA °P ll11Y�®PNldtg6@6Dft <br /> _: <br /> `'' <br /> Business Name: w <br /> ( <br /> Owner Name �. 0 LAaCarz� <br /> 1 <br /> Site Address: 20,00 G _ a <br /> GUMAddrsss <br /> Phone <br /> i ' the eeriimissaagr Owner.emend will provide the necessaay sac2'F3i es f em above me <br /> aammissetir as cir+�ioned vehicle at my � <br /> I ller4md below <br /> 1 0 <br /> ( (0Ugaid L sogd waste dispowl R Ulenst7 washing.*k 1 : <br /> I reora � a�a.�Siomfi�nfood ® Vehtrdewashfacili6es € <br /> i [(PrepamaonofNottaddwaterfardewft ®TogatLhandwastnttg store tefrigeratediopa <br /> ❑Sin dr r oodisuppom ®provide lewaier r <br /> �/ r Ouemight patiCmg �y Adsquate etaddcal dullets <br /> t .3 -46 <br /> Bignaturea, Comm 0=01110 pa <br /> tf vie cormaissarylrload establishment is oulaide am Joaquin Counwy Sae local h luftse67on mastva* t <br /> i ccs rer, heald'per.I ny siamirrg below �Raod estabtrsbsneng is In t <br /> i <br /> 1 Signatum of COUney x1mm-5' Date <br /> 600 tED77 <br /> Y28f2eeB 6af8 AWPUAPPIICAMON <br />