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0250 2��� <br /> San Joaquin County Environmental Health Department <br /> Operating Permit Form <br /> Facility Name Rise Up <br /> Site Address 941 nordic place City Manteca State CA ziP 85336 <br /> Business Phone 4155398110 <br /> SSN or Tax IDd 852946254 <br /> FaclliryMailingAddress 941 Nordic Place City Manteca state CA ZIP <br /> 95336 <br /> If mobile food truck or Ucense Plate Number VIN <br /> pumper truck <br /> Facility Owner <br /> First Name Yssur Last name <br /> Hammdan <br /> Name Address 941 Nordic Place City Manteca state CA zip95336 <br /> Mailing Address 941 Nordic Place ccv an eac state CA ZIP 95336 <br /> Phone 4155398110 Phone 4156379931 ema <br /> �osorhamdan@gmail.com <br /> osorhamdan@gmail.com <br /> Billing Party <br /> First Name Yssur Last name <br /> Hammdan <br /> Billing Address 941 Nordic Place City Manteca State CA ZIP <br /> Phone 4155398110 [Phone 4155398110 Email <br /> yosorhamdan@gmail.com <br /> BILLING AND COF <br /> 4PLIANcEK G E : 1,the undersigned Applicant, certify that I am the Owner, Operator,or Authorizers Agent of this <br /> Business,and I acknowledge that all PERWTFEEs,PENALrrES,6WORCEMENT CHARGES and/or NOuRLYCHARGES associated with this operation will <br /> be trilled to me at the address identified above as theftL114GAooREs for this site. I also certify that all information provided on this application <br /> Is true and correct;and that all regulated activities will be performed in accordance with all applicable SAN JOAOUIN CouNTY Ordinance Codes <br /> andlor Standards and STATE andlor FwtAi Laws and R ulations. <br /> Applicant Name Yssur Hammdan Signature <br /> Yssur <br /> Title Owner Date 09\26\2025 Driver's License 41 <br /> Photocopy Required) <br /> EHD Use Only <br /> Assigned To 7 r Linked PA ID <br /> Record Number <br /> p <br /> Date � PE <br /> Fee ,j/3 <br /> Permit Valid from r}//y 2rO to H2(�Po! <br /> Invoice tI❑Cash LIr !L� Amount Paid Payment Received By <br /> ❑Check# <br /> 13Confirmation it 2� 23 �g <br /> PAYMENT <br /> RECEIVED <br /> SEP 2 6 2025 <br /> SAN.JOAQUIN COUNTY <br /> ENVIRONMENTAL <br /> HEALTH DEPARTMENT <br />