Laserfiche WebLink
69% 5ANAAUIN Environmental Health qep <br />arTrerr. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility + Caterer <br />Complete sections 1 and 2. If your commissary ;s located outside of San Joaquin County also complete section 3. <br />Business Name Tacos y Mas Canadas de Obregon Lic. Plate # 8P93033 <br />ownerfOperator.Name Leoncio Jaure uq i _ <br />business Mailing Address 2052 Nightingale Ave <br />City Stockton state. CAzip 95205 Bus. Ph. (408) 856- 5193 Aft, Ph. <br />I. , hereby state that the above information is current, true and correct to <br />the best of my knowledge and agree to utilize my approved commissary in accordance with California Health & <br />Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br />commissary is discontinued, the perrnh holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and nsWas. <br />Slnnature Date 10/4/2021 <br />Commissary Name California Catering Truck Wash FA# (209) 464-9707 <br />Address 730 S California St Bus. Phone (209) 271-1741 <br />City Stockton Zip 95203 �tlOwner/Operator Salvador Buenrostro <br />Check all appropriate services provided:: <br />NeWastawater disposal V3 -Compartment sink VEiectricsi hook-ups <br />Solid waste disposal Food preparation /Toilet and handwashing <br />Hot & Cold water for cleaning VeStore refrigerated food /Potabla water <br />Store dry foodlsuppiles Vovemignt parking Y vehlclo wash <br />1, , hereby state that the Information I have provided Is current, true and <br />correct to the best of my knowledge, and masts the Callfomis Health & Safety Code requirements. If the food facility <br />operator falls tq,�mply with the conditions of this agreement, or If this agreement is modified or cancelled. the <br />commissary. of+jfer 0611 noofy the/Ej10 immediately. �4 l I _ I „ I <br />The commissary is located in County. The above food facility meet$ the <br />commUsiry requirements in CalNomie Health & Safety Code The above checked services are avellable at the <br />above commissary. Please notify EHD if the status of their operating permit changes <br />REHS Sipnaturo �, Data p _- _ _ w m v <br />1868 E. Hazelton Avenue 1 Stockton. Caiiforria 95205 � T 209 466.3420 1 F 209 464.0138 1 uww.sigov.orgiehd <br />