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Please provide all infen-nrition requested. An irioempleto appliention may dolay approval. <br />_ -- <br />VEHICLE INFORMATION <br />Vehicle Name (DBA): \A/6 „to pd Atc, DA) g(S771 <br />Address for Vehicle:/.f-J ? <br />Street Address <br />City <br />License Plate #: 11-F(,-)&ZO g 4) Year: <br />Vehicle Vin #: 1-14Cra)VaDgle.init-Cic 5) Make/Model: <br />State Decal #: 215-05-2.— 6) Color: <br />f my k UT, L <br />ScAlimm. <br /> <br />VERICtIMMER;INFORMATION <br />Name: DA")/6-2_1_6 3/3-,006es <br /> <br />Address of Owner: s--70 E4s FS S 7-1-7 A <br /> <br />Street Address <br /> <br />City <br />The mobile food facility shall operate out of a commissary and shall report to the commissary at least once each <br />operating day for cleaning and servicing (CalCode sections 114295 & 114297). If the use of the commissary is <br />discontinued, the permit holder mu_st notify this office to make the necessary changes. Failure to notify this office may ult in ermit revo tron and penalties. <br />Sign. .re of Vehicle O <br />) <br />perator Date <br />C • 6114 .167;i:RY INFORMATION <br />Business Name: 4/1::, u 56- <br />Owner Name: S-e-cve CiA, AlCDLCAJ <br />Site Address: 2...c /.1Th1 rd Qa kact <br />Street Address <br />Phone: (2-09 ) ge/7-s-c, / <br /> <br />Y5 101 <br />City <br /> <br />I, the commissary owner, can and will provide the necessary facilities for the above mentioned vehicle at my <br />commissary as checked below: <br />9 5:5 / <br />0 Liquid & solid waste disposal <br />ri Preparation of food <br />n Store dry food/supplies <br />cl.Aviir\-tedkJ, <br />El Utensil washing sink 0 Store frozen food (2 or 3 compartments) <br />11 Hot & cold water for cleaning 0 Toilet & hand washing <br />0 Provide potable water 0 Overnight parking <br />- - <br />Date jiSignature 0.:gCgOriisisa Owner/Operator <br />E T <br />0 Vehicle wash facilities <br />earl Store refrigerated food <br />0 Adequate electrical outlets <br />If the commissary/food establishment is outside San Joaquin County, the local health juris lotion must verify current health permit by signing below. Commissary/food establishment is in ci 11 County. <br />Signature of County RENS <br />5- <br />Date <br />HD 16-017 ' <br />'1 8/2 008 <br />5 of G <br />MFPLI APPLICATION