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rSANAMUIN Environmentai Health i7e at-t.mtrnt <br />COMMISSARY AGREEMENT <br />Mobile Food Facility+ Caterer <br />Complete sections f and 2. if your commissary is located outside of San Joaquin County also complete section 3. <br />Business Name Tacos y Mas Canadas de Obregon _L,c. Plate # 8P93033 <br />OwneriOperator.Name Leoncio Jaurequi <br />Business Mailing Address 2052 Nightingale Ave <br />City Stockton State- CAZip 95205 Bus. Ph., (408) 856- 5193 Alt. 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 permit holder must notify the EHD. Failure to notify this office may result In permit <br />revocation and naltles. <br />Aienatura � _ Date_10/4/2021 <br />Commissary Name California Catering Truck Wash FA# (209) 464-9707 <br />Address 730 S California St —Bus. Bus. Phone (209) 271-1741 <br />City Stockton 7jp 95203 8wnerlOperator Salvador Buenrostro <br />Check all appropriate services provided: <br />Wastewater disposal V3•compartment sink 1/Eiectncal hook-ups <br />gSoiid waste disposal Food preparation VToilet and handwashing <br />/Hot & Cold water for cleaning Store refrigerated food ffi__� /.Potable water <br />Y Store dry food/supplies VOvemigi�t parking V Vehlcie wash <br />i , hereby $-late that the information I have provided Is current, true and <br />correct to the fest of my knowledge, and moats the California Health & Safety Code requirements. If the food facility <br />operator falls to,�bmpiy with the conditions of this agreement, or if this agreement Is modified or cancelled, the <br />commissary o"r) <br />The commissary is located In County. Ins above food facility meets the <br />commissary requirements in California Health & Safety Code The above checked services are available at the <br />above commissary, Please notify EHD if the status of their operating permit changes. <br />RENS Signaritrs <br />7368 E. Hazelton Avenue I Stockton, California 95206 T 209 $68.3420 I F 209 464-01;18 1 www.sjgcv crgrend <br />