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VERIFICATION OF RESTROOM FACILITY <br />Please provide all information requested. An incomplete application may delay approval. <br />VEHICLE INFORMATION <br />Vehicle Name (DBA):TAI'MA'ANAO MANUNU <br />Address for Vehicle: 1717 S UNION ST STOCKTON, CA 95206 <br />Street Address City <br />License Plate #: 5Z51032 4) Year: 1999 <br />Vehicle Vin #: 1GBKP32R6X3305288 5) Make/Model: CHEV/P TRUCK <br />State Decal #: 6) Color: WHITE <br />VEHICLE OWNER INFORMATION <br />Name: HENRE LOSONGCO <br />Address of Owner: 1003 LAKE PARK AVE #130 GALT, CA 95632 <br />Street Address City <br />Mobile food facilities shall be operated within 200 feet of approved and readily available toilet and hand washing <br />facilities. This is to ensure restroom facilities are available to employees whenever the mobile food facility is <br />stopped to conduct business (CalCode section 114315). <br />I have access to the restroom facilities at the following business during my business hours and I am parked less <br />than 200 feet ayvay from the restroom facilities. I will be responsible for maintaining the restroom in a clean and <br />sanitary co ion. 4_ <br />Signatu f Vehicl Operator Date <br />RESTROOM INFORMATION <br />Business Name: MORE FOR LESS <br />el Owner Name: Cim a n) -1 cj trva.) i it.., Pc - S' C ti MUIT Th <br />Site Address: 702 N LINCOLN WAY GALT, CA 95632 <br />Street Address City <br />Phone: (209) 745-4974 <br />I, the business owner/operator, can and will provide the necessary restroom facilities for the operators of the <br />above-mentioned vehicle at my business and I understand that the restroom facilities are subject to <br />Environmental Health epartment inspection. <br />.-.,4 li dibli 3- /2- 2c) <br />Sign ture Business owner/Operator Date <br />EHD 16-017 <br /> 6 of 6 <br /> MFPU APPLICATION <br />7/28/2010