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RUFUCAMN OF VEHOCLG COMi 08SA` Y <br /> ielease proulde all Inforrrt60on reqraesited. An incomplete application may delay approval. <br /> / i- <br /> RddreBs for Veffiole �(i ..C�l� <br /> SWftAddrMS U �o�O <br /> s � <br /> E %V G L�iagt�sePt�e�: 4) Year. <br /> t 2) Veiiicte U`iCt�: � • is 1 �N OC�'LG�%� �a l�akel�odei: ��.�� <br /> i <br /> Decal P6 Color. <br /> Narne:Ad dress of owner: <br /> i S��Addr2ss '�' �i <br /> Qtifle mod facility shall®pew�Of a cygyr L F <br /> ,,c� �r ane sinall'�o>��o�e coujoilmsW <br /> i O;?e3` MCT dQy far el@aning andu <br /> sacing(gmjgadg sections qja a�B4 M th <br /> h aE f omce eacT� <br /> 6s�e�arlr� , If <br /> use of the o0makepsi is <br /> Ift paMaaf:molder must RMI&I MID office to maim the necessanj changes: allum to WM�. <br /> ��'f G�6'�'s�t�f FPSFt��IFd��F3�3E'd FGVOC2�i0Ff a3EE�,e�e��[BS. .. <br /> 1/.re<?ri(Gem ��{� �L.�1 t— % 0, --� <br /> S, nature of Vehicle Operator <br /> Business Name: �JO <br /> Ovner Na mg-- �—�, �. 1' � =t ! 90 s <br /> f�l s� <br /> Site r ddreas: L1 V 1 ," _ °'/' �, <br /> sWesr:Addrass ..� � <br /> Phone: (0LA-i.I <br /> OOmmrssarf owner,can and mill provide ihe pgjecessaW,ac-Iffles foPae aToove 51asii©Fled�resaicie aE G535i <br /> t;B3 EitiSudE j 85 chec.�ted belour <br /> Liquid a soitd waste&,Do ) Utensil gashing sink <br /> } taor3 empm t0,40 Etre toz.tien nod vehiclewa8tr l"dcui s ° <br /> Q Pfeparaum of fooei Haf&e�id water ter etaarur�g Toilet a hand washtg Q store reWmwam rand <br /> I Q 5 dnf modlsuppties Provide potable lNa4erQ Overnight panting Adequae etectrtcal outieis <br /> a G t3 <br /> Signature of GoHm"mi t)tnrrterfQ13eraio DamPA <br /> s <br /> :i <br /> Pr.the oemaieseeylroad eatakrfthiment is or de San Joaquin County,the low health jut dfction tneset:ve <br /> i CUM'Srit heath perzA-se by s;gsim.9 betavU- vo,- ssa�lroor3 es�i�l'r$13�eni is ria <br /> C�oLtrt��f. <br /> I giztaEvre of County P941S ®ale <br /> EHD 1"17 Sofia <br /> 7118r20�B MFFU APPLiCAMOM <br />