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Please provide all information requested. An incomplete application may delay approval. <br /> 'ehicle Name(DBA): TANS _0 C 41 Y�(1� <br /> .ddress for Vehicle: ✓ y <br /> Street Address City tip Code <br /> 1) License Plate#: A 4) Year. Iol�l <br /> 2) Vehicle Vin#: �C-LD 5) Make/Model: <br /> 3) State Decal#: 6) Color: <br /> OCh�- <br /> .ddress of Owner: LOA) 2 <br /> Street Address City Zip Code <br /> he above-mentioned vehicle shall operate out of a commissary and shall report to the commissary at least <br /> rice each operating day for cleaning and servicing [CURFFL 114265,& 114287]. If the use of the <br /> i,mmissary is discontinued,the permit holder must notify this office to make the necessary changes. <br /> ailure to notify this office could result in permit revocation and penalties. <br /> anat»rP of VP � P(1nPratnr TlatP <br /> usiness Name: S �• i <br /> wner Name: f 1 <br /> ite Address: <br /> Street Address City Zip Code <br /> none: ( - ) - c , <br /> the commissary owner, can and will provide the necessary facilities for the above mentioned vehicle at <br /> iy commissary as checked below: <br /> Liquid&Solid waste disposal ❑ Utensil washing sink Store Frozen Food Provide ice <br /> (2 or 3 compartments) <br /> Preparation of Food Electrical Hook-up Toilet&Hand washing Vehicle Wash Facilities <br /> Store Dry Food/Supplics Provide potable water Overnight Parking ❑Store Refrigerated Food <br /> i tur ofricrommissary wn / , rator Date <br /> the commissary/Food establishment is outside San Joaquin County,the local health jurisdiction shall <br /> erify current health permit by signing below. Food establishment/commissary is in <br /> County. <br /> ignature of County E.H.S. Date <br /> :HD 16-01-013 Page 8 of 8 MFF APPLICATION <br /> /1712003 <br />