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SAN-]OAQUIN Environmental Health Department <br />--COUNTY- <br />- (�reGtn°zs Grows her - <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 />1. To be completed by APPLICANT <br />Business Name EI Gato Volador Lic. Plate # 4SV2622 <br />Owner/Operator Name Luis N Martinez <br />Business Mailing Address 21435 Scorral hallow Rd <br />City Triwy State CAZip 95304 Bus. Ph. 209 814 4278 Alt. Ph <br />I, �"— r� , hereby state that the above information is current, true and correct to <br />the best o <nowledge 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, theper er must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. '/�� <br />Signature Date 11/9/2021 <br />12. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FA# 209 464 9707 <br />Address 730 S. California St Bus. Phone 209 464 9707 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro <br />Check all appropriate services provided: <br />04-lastewater disposal 12.3 -compartment sink C1,16ectrical hook-ups <br />M"Solid waste disposal Ef"Food preparation toilet and handwashing <br />C'I <br />Hc t & Cold water for cleaning tore refrigerated food CYPotable water <br />Store dry food/supplies Overnight parking 131Gehicle 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 with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissaryw er shall n fythe EHD immediate <br />%� <br />Signature I - h-,( /lA I'm Irl I 1,(/LA -Patel 1/9/2021 <br />1 3. To be completed by the ENV HEALTH iurisdiction outside of San Joaouin Co. I <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 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br />