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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY— <br />Greatness grows her, <br />COMMISSARY AGREEMENT <br />Mobile Food Facility • Caterer <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />To be completed by APPLICANT <br />Business Name El Gato Volador <br />Owner/Operator Name Luis N Martinez <br />Business Mailing Address 21435 Scorral hallow Rd <br />City Tr y State CAZip 95304 Bus. Ph. 209 814 4278 Alt. Ph. <br /> , hereby state that the above information is current, true and correct to <br />the best o nowle ge 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 perm: • , er must notify the END. Failure to notify this office may result in permit <br />revocation and penalties. <br />Signature <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FM 209 464 9707 <br />Address 730 S. California St Bus. Phone 209 464 9707 <br />City Stockton <br /> <br />Zip 95203 Owner/Operator Salvador Buenrostro <br /> <br />Check all appropriate services provided: <br />astewater disposal 121'31co m p a rt m e n t sink <br />1:14olid waste disposal liFood preparation <br />Ellgt & Cold water for cleaning Elltore refrigerated food , <br />Of Store dry food/supplies Er Overnight parking <br />D4lectrical hook-ups <br />Dzfoilet and handwashing <br />D'Potable water <br />13'<ehicle wash <br />I, ,hereby state that the information I have provided is current, true and <br />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails to comply w th the conditions of this agreement, or if this agreement is modified or cancelled, the <br />i <br />shall n fy the EHD immediate <br />t/f <br />To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in County. The 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 />REHS Signature Date <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd <br />Lic. Plate # 4SV2622 <br />Date 11/9/2021 <br />commissary <br />Signature Date11/9/2021 <br />