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JAN J OAQ U I N Environmental Health Department COMMISSARY AGREEMENT Mobile Food Facility _ Caterer Complete sections f and 2. ff your commissary is located outside of San Joaquin County also complete section 3. 1. To be completed by APPLICANT Business Name Durango's Cafe Lic. Plate#4AL1811,4TZ8093 Owner/Operator Name Ibarra Fernanda Business Mailing Address 1660 Beyer Ln dity Stockton StateCA Zip 95215 Bus. Ph. 209 323 0885 Alt. Ph.209 628 9557 I, hereby state that the above information is current,true and correct to the best of my knowledge and agree to utilize my approved commissary in accordance with California Health & Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the use of the commissary is discontinued,the ermft holder must notify the EHD. Failure to notify this office may result in permit revocation a penalties. Signature .fieG1 Date 1/20/22 2. To be completed by COMMISSARY OWNER/OPERATOR Commissary Name California Catering Truck Wash FA# 209 464 9707 Address 730 S. California St Bus. Phone 209 464 9707 City Stockton, Zip 95203 Owner/Operator Salvador Buenrostro Check all appropriate services provided: /Wastewater disposal i3-compartment sink Electrical hook-ups jr solid waste disposal OFF d preparation (y Toilet and handwashing Hot& Cold water for cleaning /Store refrigerated food W Potable water 2Store dry food/supplies eOvemight parking 2 Vehicle wash I, , hereby state that the Information I have provided is current,true.and correct to the best of my knowledqe,and meets the California Health&Safety Code requirements. If the food facility operator fails to comply with the conditions of this ement, or if this agreement is modified or cancelled, the commissary om ner shall notify the EHD immediatel Signature Date 1/20/22 3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. The commissary is located in County. The above food facility meets the commissary requirements in California Health & Safety Code. The above checked services are available at the above commissary. Please notify EHD if the status of their operating permit changes.