Laserfiche WebLink
the commissary owner, can and will provide tile necessary facilities for the above mentioned vehicle at my <br />commissary as checked below: <br />E Liquid & solid waste disposal <br />7 Preparation of food <br />Store dry food/supplies <br />Utensil washing sink <br />(2 or 3 compartments) <br />EHot & cold water for cleaning <br />ZProvide potable water <br />7 Store frozen food -4 Vehicle wash facilities <br />Toilet & hand wathing 7 Store refrigerated food <br />la--Overnight parking Adequate electrical butlets <br />VERIFICATioN OF VEHICLE COMIMSSARY <br />Please provide al/ information requested. .0m incomplete application may delay approvaL <br />. c•-:,, - ' i ' ' • ' ' • -i. ' . - • : y , <br />Vehicle Name (DBA): 14_4E5 _._o_vomx.L cA \,4._ loko\oe,v-1 G\ <br />Address for Vehicle: G Li -+ bi .%ayirivc____ , Loa\ oft 959„42. 3, \ols QAT_ _5-k- <br />Street Address City <br />1 1) License Plate #: 7 Y.6 9:7C Y 4) Year: <br />Vehicle Vin #: /A/1?7,z A we sso 93C ' 5) Make/Model: tr/q/Cifi) <br />State Decal #: 6) Color: g <br />. ' <br />Name: f Z 5-4 2Y <br />Address of Owner: 9/ f N. /71/4 j tv-4,v. if ch // (-44 5Acch$1, (‘A -)1(9110Z Street Address ---1 / City I <br />The mobile food facility shall operate out of a commissary and shall report to the commissary at least once each 1 <br />operating day for cleaning and servicing (CalCode sections 114295 & 114297). ff the use of the commissary is <br />discontinued, the permit holder must notify this office to make the necessary changes. Failure to notify this office may result in permit revocation and penalties. <br />1 5 Ck N S,C.14:a ii ....te - °to 1 pi Signature of Vehicle 0 .,erator Date <br />- <br />Business Name: 4 -Cfp,' ' 6—g/I <br />Owner Name:, <br />Site Address: im/ <br /> Street Address City <br />Phnnp• t If10') -7-7 ti.,- : <br /> <br />S- nature of Commissa ..,..ain/eriOoerator Date <br />If the commissary/food establishment is outside an Jc quin County, the lock', health jurisdiction must verify <br />current health permit by signing below. Conlmissz.7,e/food establisi.ment is in <br />County. <br />Signature of County FENS Date <br />HD 16-017 <br />/18/2008 <br />5 of 6 MFPU APPLICATION