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| New Facility □ Existing Facility <br />San Joaquin County Environmental Health Department <br />Application Form <br />Facility Name : TORTILLERIA LOS ANGELES <br />ZIP: 95City: LODI State : CASite Address : 610 S CHEROKEE LN <br />Supervisor DistrictAPN <br /> Change of Owner Repairs or Remodel Other Consultation <br />Comments: FOOD TRUCK/ TORTILLERIA MOVIL DE TORTILLAS DE MAIZ <br />License Plate Number: PENDING VIN: PENDING <br />| Facility Contact| Billing Party | Facility Owner o Architect Property Owner Contractor <br /> Facility Contact Property Owner Contractor Architect Billing Party Facility Owner <br />If contractor, indicate type and license numberLast name : JUAREZFirst Name : ISAAC <br />City : LODI State : CA ZIP: 95240Address : 1022 S WASHINTONG ST <br />Phone : 2093277294Phone:2096631352 <br /> Architect Facility Contact Property Owner l Contractor Facility Owner Billing Party <br />If contractor, indicate type and license numberFirst Name Last name <br />City State ZIPAddress <br />Phone EmailPhone <br /> Architect Facility Contact Property Owner Contractor Billing Party Facility Owner <br />If contractor, indicate type and license numberFirst Name Last name <br />City State ZIPAddress <br />EmailPhonePhone <br />Contact Types <br />required <br />Type of Service <br />Requested <br />If mobile food <br />truck or pumper <br />truck <br />| Application for <br />Operating Permit <br />Email: <br />TORTILLERIALOSANGE <br />LES15@GMAIL.COM