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RE�t JE® <br /> JUL 2 0 t�ECD <br /> w��� RA COUNTY <br /> SpEp7 p ENVI ONMENTAL HEALTH <br /> Department of Environmental Health <br /> MFF Out of County Commissary Approval Consumer Protection Division <br /> 1555 Berger Drive,Suite#300-San Jose,CA 95112 <br /> (408)918-3400•Fax:(408)258-5891 <br /> Website:aeawr-panto orn•Email:dehweb@cep.sccgov.org <br /> Type of Vehicle(check one): <br /> Occupied Vehicle(Truck,trailer,van,bus) E3 Non-Occupied(Cart,trailer) [3 Ice Cream/Produce <br /> Business Name: <br /> License Plate Number:_LNOQ> S3 Last 6 Digits of VIN Number: 2%t3c( � <br /> Name: NManna Phone: ttaij 22.7 -7h2S <br /> Home Address: 7(aq 1A) , Ainhgi n, j�rrri -IC-" , tq-- 9&-T <br /> Email address: t ;11►P h E 2MA%I . CGVI''I <br /> Santa Clara County Permit Expiration Date: Facility ID: <br /> Approvals for Santa Clara County MFF permit holders will not be granted if renewal inspection has not been scheduled, permit is <br /> expired, or if a balance on the account is due.Account must be in good standing. <br /> 't) <br /> d <br /> Commissary Agreement Form will be emailed to the permitting county. <br /> You will be copied on the email <br /> -rte z q -�7 V-�-4 <br />