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RIFICA) uON OF VENDCLE COMMMARY <br /> please provide aff insonation mquest&d. An incomplete:application may delay approval. <br /> 77 <br /> Vehicle Name(DBA): <br /> !Address far Vehicle ? .� <br /> . SCeeCAddt� � i <br /> �1 tic®nse Ptafie : rf.� !rr/ P 4) Year. /f fj _ <br /> ! 2) Vehicle Vin r g <br /> /��1l�� sk oo���► MOWdodet G ✓IZ� 1 <br /> S) State Decal 0: _� 6) Color. <br /> Name: <br /> Address of Owner p l <br /> shBet <br /> crW <br /> 9s`3 <br /> ' The r:tobiie rood facility ssbali operate out of a conanbeeW and sbaii Mpolt to the eo ) <br /> aperef RS day far cleaning and s®rvioing(�Sede dgstions 994�a&49 `at least oe�;eaob <br /> discontinued,The Remit bolder must waft ti➢ie®file&to make then ssom If the ase of the rs €y is <br /> i offloa msnl resultiu e E Celtooatrfiedtd p changes Failure to ndt�'; we <br /> it t. <br /> s Si nature t o r p <br /> l`nn(^��.,pppq//p¢��gry -A�{g�p�j`-�p..�n{,�.q.I_a0.gf� .: .., _ <br /> Business Name: <br /> IOWnerNams. <br /> Site address: q U() c C - <br /> StreetAddmss b <br /> I Rhone:() &JiJ�'E am <br /> ',:he camn�issaryr owner,emend vuill provide the neeeaswy facilities for the above mentioned vehicle at m <br /> cosnmi9saly as cbeaked below: i y <br /> iLiquid&soda waste dfspa" �Udet>stl washigg sink f(aeen shad Vencle wash f2 IMS <br /> a�ml <br /> [�Ptepersdan of toad Hot&Cold waterfhrdewft ®Twlet&hand waehklq d] StMMISMaratelfbod <br /> i ❑Sm fnhd/suppGes ®pmuids waderi s <br /> ovemight pa iems Q Adequate electrical duvets <br /> i Si nature of Gomm Ownerlo Date <br /> 2_1 Lrra <br /> !f the cdmraisserylfood establishment is oulaide,San Joaquin County,the lddal lsealiEl ju�isdidtiOn!PlEi82vertfy <br /> i Current health permit by signing below ia=ng8ea{ g00d estabfrshsnen$is in <br /> ICaunCy. i <br /> F 1 <br /> signature of County RENS own <br /> HBRaQe 60f6 MPPUAPPL(CAMOM <br />