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The Wayback Machine - https://web.archive.org/web/20160123012227/http://www.sjcehd.com-80/doc... <br /> VERIFICATION OF VEHICLE COMMISSARY <br /> Please provide all information requested. An incomplete application may delay approval. <br /> 1/ECLE>1111F710N <br /> Vehicle Name(DBA): <br /> Address for Vehicle: <br /> Street Address city <br /> 1) License Plate it. -A) ;,24) Year: <br /> 2) VehideVin#-lr-t3XEyhSpai�FI&3f'*5 5) Make/Model: i'� <br /> 3) State Decal# 6) Color- <br /> VEHCCE tl0N <br /> Name: vk- <br /> Address of Owner: '� <br /> Street Address pity <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 114296& 114297). If the use of the commissary is <br /> discontinued,the permit holder must notify this office to make the necessary changes. Failure to notify this <br /> office may--tint in-permit revocation and penalties. <br /> Signature of Vehicle Operator' Date' <br /> Business Name: <br /> Owner Name: <br /> Site Address �p ZlJ cs�� t cSI` '� ZS'd <br /> Street Address City <br /> Phone: ( ) <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 /> quid&solid waste disposal ��washing sink <br /> R or 3 can partrnerrts) I I�mre frozen food Vehicle wash facilities <br /> .y"'"" <br /> ❑ reparation of food Hot&cold water for cleaning oilet&hand washing 2 Store refrigerated food <br /> Ot-tore dry food/supplies - de potable water DO-might parking �te electrical outlets <br /> Si nature of ommissa Owner/Operator Date <br /> HEIkL��Ea, IENT <br /> If the commissary/food establishment is outside San Joaquin County,the local health jurisdiction must verify <br /> current health permit by signing below. Commissary/food establishment is in <br /> County. <br /> Signature of County REHS Date <br /> EHD 16-017 5 of 6 MFPU APPLICATION <br /> 7118r2008 <br /> PK215D)i%%R )F <br /> https.//web.archive.org/web/20160123012227/h"p://www.sjcehd.com/does/Verification_of Vehicle_Commissary.pdf 8/10/24, 2:32 PM <br /> Page 1 of 3 <br />