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Street Address City Zip <br />City <br />^TO gUTOa)OF <br />go 77 <br />re <br />Page 6 of 6 MFPU APPLICATIONEHD 16-017 <br />8/4/2006 <br />License Plate #: <br />Vehicle Vin #: <br />State Decal #: <br />Year: <br />Make/Model: <br />Color: <br />1) <br />2) <br />3) <br />------------ - <br />VERIFICATION OF RESTROOM FACILITY <br />Please provide ail information requested. An incomplete application may delay approval. <br />Vehicle Imoraiation <br />Vehicle Name (DBA): <br />Address for Vehicle: <br />Zip <br />7 5 <br />Date <br />7-)2- <br />Date <br /> 4) <br /> 6) <br />I <br />—JOULT- <br />lusmess owi^er/Operator <br />Mobile food facilities shall be operated within 200 feet of approved and readily available toilet and hand <br />washing facilities. This is to ensure restroom facilities are available to employees whenever the mobile <br />food facility is stopped to conduct business. CalCode Section 114315. <br />I have access to the restroom facilities at the following business during my business hours and I am <br />parked less than 200 feet away from the restroom facilities. I will be responsible for maintaining the <br />restroom in a clean and sanitary condition. <br /> <br />Signamre of Vehiclpj^perator <br />Restroom Information <br />Business Name: A AJ <br />Owner Name: <br />Site Address: K) \5^ \ /0 <br />\ 11 hcle Owner Information <br />GcLZaO <br />Address o f Owner: | g / S cyioA Qi? <br />Street Address <br />OH- *STod<FC)N go-H r: Z-AJ <br />Street Address City Zip <br />Phone: Z-O6! - 30 5 LjO * ( <br />I, the business owner/operator, can and will provide Hie necessary restroom facilities for the operators of <br />the above-mentioned vehicle at my business and I understand that the restroom facilities are subject to <br />Environmental Health Department inspection.