Laserfiche WebLink
j." StANJ1 AWN Environmental Health Department <br />---COLJ NTY..__ <br />170"'Or/1 <br />COMMISSARY AGREEMENT <br />Mobile Food FaclNty a Caterer <br />Complete sections f and 2. it your commissary is localed outside of San Joaquin County also complete secacn 3. <br />Business Name Delicias La Piedad —_ L c. Plate #_ 8A46711 <br />Owner/Operator Name Jose L. Zarate <br />Business Melting Address 1441 S. American St <br />Citv Stockton State Ca Zip 95206 Bus. ph, (209) 641-4775 Alt. Ph. <br />�. Jose L. Zctrate 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 Caltftanla Health & <br />Safety Code, and Sen Joaquin County Environmental Health Department (EMD) 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 a penalties. <br />Signsturs cine? � Data 10/6/2021 <br />Commissary NsmeCalifornia Catering Truck Wash FA# <br />Address 730 S. California St Phone (209) 464-9707 T_ <br />City Stockton Zlp 95203 ­_ Owner/operator Salvador Buenrostro <br />Check all appropriate services provided <br />0 'Wastewater disposal 13 3 -compartment sink O Electrical hook-ups <br />0 Solid waste disposal O Food preparation D Toilet and handwashing <br />0 Hot & Cold water for cleaning 0 Store refrigerated food p Potable water <br />E3 Store dry food/supplies 0 Overnight parking Q vehicle wash <br />1. hereby state that the information I have provided Is Current. true arc <br />correct to the test of my knowledge, and meets the California Health & Safety Code requirements. If the food fatuity <br />operator fails "mply with the conditions of this agreement, or If this agreement Is modified or cancelled, the <br />commissary a�{{y(er 11no thq/E}tD Immediately 'f <br />�,,L 10/6/2021 <br />The commissary is located in _County. 'fne above food facility meals the <br />commissary requirements in California Health & Safety Code The above chocked services are avaliaole at the <br />above commissary. Please notify EHD if the status of Meir operating permit changes. <br />REHS SlgrtaNro _...._ Date__,._..._ ,e <br />1868 E. Hazelton Avenue i Stockton, California 96205 1 T 209 468-3x20 ; F 209 464-0138 www.slgov.orA;enc <br />