Laserfiche WebLink
Name: L5Q.C.. <br />Address of Owner: t420 Co <br />h <br />75t Lcs, tIt42_ <br />Street Address <br />ck <br />City <br />Siinature of Vehicle erator <br />E Utensil washing sink <br />(2 or 3 corripartraontx,) <br /> E Store frozen food a:Vehicle wash facilities <br />ot 8, cold water for cleaning Eteollet & hand washing Store refrigerated food <br />rovide potable water E Overnight parking Adequate electrical outlets . <br />'11 <br />of <br />maTrdr14,3•P`' ' <br />tail /0 orator <br />e4'2 <br />Date <br />_ Atb-kagmeragesNidemmmoinim"------ <br />VERIFICATiC)N OF VEHICLE COMMISSAR <br />Pleaso provido all infonnatioirsoittaci. An incomplete applicatIon "1"IY r <br />arogyirti <br />• <br />Vehicle Name (DEIN: Desr _- Address for Vehicle: I-- • <br />Street Address * <br /> <br />License Mete #: K48 4) Year: <br />Vehicle Vin #: .°BC q i A 222-3Pq21-1 5) Make/Model: _QTY- <br />State Decal 4: ecag 6) Coloi': 4r-t <br /> <br />,14.-Vs <br /> <br />. v.; <br />v v • <br />".."1 <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 114296 & 114297). If the use of the commissary is <br />discontinued, the permit holder must notify this office to make the neceSSnry changes. Failure to notify this <br />office may result in pj revocation and penalties. <br />0 2_101 /2. Lim <br />Date Yfiti.' 4 ' tr'• . <br />‘121/1 <br />City <br />l'3^••"j ty: <br />'34 e't• <br />S. <br />4-Fril -15 <br />Business Name: <br />Owner Name: ji <br />Site Address: ad <br />Street Address <br />Phone: ( q) <br />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 <br />E Preparation of food <br />El Store dry food/supplies <br />Si nature of Commissa <br />• <br />If the commissary/food establishment is outside San Joaquin County, the local health jurisdiction mu verify <br />current health permit by signing below. Commissary/food establishment is in <br />County. <br />----- Signature of County REHS <br />visto.e <br />vi owe <br /> <br />Mt`Pli APPLICATION <br /> <br />06 <br />