Laserfiche WebLink
Please prouide all informai;ioa mqueated. An incomplete application may delay appeeval. <br /> Vehicle Name tDBA�: <br /> "22oi. <br /> I: <br /> Address for Vehicles <br /> i Sftat Address 7 <br /> tti1t�F <br /> } Ucanse Plate 0: 4) Year: <br /> I 2) Vehicle dirt �fil bS� Niake111 ocW: z , <br /> 3} Std Deoal P G 6} Color. <br /> Mame: <br /> address of 0.... <br /> S4s2at ddrass � - <br /> '!Ic obiie 100d facility, shall operate out&a comrniss <br /> 2s,39YMUOT d0y fel'eleanin and-ser i6i �Y and shall report LO the Carnetussaey Sir least once;�cis <br /> ng (CS16®de s®s;21ens 894293 1142 �), if the easeea. or-failure <br /> the ofl enissa�+J is <br /> 1 Isce�aLlr� �, e,permit holder muse Rol iffy We csfce $6 Make the necesswj cha�c railure to no*ems <br /> o tce Flay result in permit revocation and pwaWes. <br /> 1_{(sy_i n}}}y{{{a+lt�,r!�e{pgof�Ip� Me operator <br /> Dab <br /> ` V�iYYYIIv QY.Y l�{i."" `Y•'wu 7 tli`CIIY Y _.1_ y h-lTIT !! !��_• «� ! 3 <br /> Business Name: <br /> C- 30 <br /> Owner Name: � <br /> `' <br /> ' <br /> Site address: OC) n <br /> S&�9tAdd A qo20CTI , <br /> Phone:(20 <br /> i <br /> ! ?,the OOmmissanj owner,can and will P-roid le the necessary facies for the abous�rass�i�o;7aee��reY�icie at ony l <br /> G@di•missanj as Checked beiaw: a <br /> ` Liquid @ solid waste disposal Utensil washing sink <br /> { t2ara caMpamnatns? �°�' O Store frozen fbod Vehicle wash facilities } <br /> Y <br /> ❑Preparation of food of a cold water for cleaning ®Toilet hand washingiQ Store refr[gerafed mod <br /> Q ' ra mod/supplied '` Provide otable water <br /> i P Ovemight parking Adequate Wectliicai oufiets <br /> 1 3 <br /> f Sprlafure Of Co 5s Otw nerf0 erawr f -Dab ; <br /> F. <br /> t it Lri�aorrarcisadrylfoocl eatabiishment is oufsidO San Joagoin County,the iocel hegith joeftdction t�eust ue�+J <br /> i Current health lawmit by si063"M-9 beiav� �s�r3�issarlllfood esi�iolish�en is iia <br /> k Signature of Ooumy REHS Date <br /> EHD 78-017 a of 6 <br /> ?1t8r2U�B WPU APPLICA7IOM <br />