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- ... , L- - VEHICLE INFORMATION - , <br />-L.- <br />yehicle Name (DBA): Pepito Enterprises. LLC <br />Address for Vehicle: 238 Pennant Ave. Lathrop, Ca 95330 <br />Street Address City <br />License Plate #: 2498ZE 4) Year: 2007 <br />Vehicle Vin #: WA98242801 5) Make/Model: SOUH / BOX <br />State Decal #: 6) Color: Yellow <br />VEHICLE OWNER INFORMATION <br />Name: Jose Miguel Ruiz <br />Address of Owner: 238 Pannant Ave. Lathrop, Ca 95330 <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 m It in permit revocation and penalties. <br />/ / ) April 12th 2018 <br />Sig 96, of Vcle Operator Date <br />CEIMMISSARY INFORMATION <br />Business Name: Cold Storage Commissary Inc. DBA: La Comisaria Modesto <br />Owner Name: Arturo Vaca: Manager <br />Site Address: 500 7th St. Ste. D Modesto, CA 95354 <br />Street Address City <br />Phone: ( 209) 338-3663 <br />I, the <br />commissary <br />commissary owner, can and will provide the necessary facilities for the above mentioned vehicle at my <br />as checked below: <br />sink & solid waste disposal Utensil washing Store frozen food X Vehicle wash facilities (2 or 3 compartments) <br />of food X Hot & cold water for cleaning I XI Toilet & hand washing I I Store refrigerated food LI Preparation <br />X Liquid <br />Store dry foqd/supplies X Provide potable water I i Overnight parking LI Adequate electrical outlets <br /> <br />,,_._—.1 ) <br /> <br />7 -"---i-‘e...--1 r April 12th 2018 <br />SAnature of Commissary Owner/Operator Date <br />REALTH DEPARTMENT <br />If the <br />Goil <br />currenthealth <br />commissary/food establishment is outside San Joaquin County, the local h?alth jurisdiction,must verify <br />permit)sy,signing below. Commissary/food establishment is in (>--coastacus <br />I <br />iy. _,--) <br />( ' iL ,. 1111 <br />Signature of County FkEHS , Date 1 I <br />END 16-017 <br />7/18/2008 <br />This form will expire with our <br />commissary on this date 5 of 6 <br />EXPIRATION , <br />DATE R 3 / • / MFPU APPLICATION