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SAN 10AQUIN <br />U1\1Tv-- <br />r rivirorver tental Health Department <br />COMMISSARY AGREEMENT <br />Mobile Food Facility $ Caterer <br />Complete sections 1 and 2. ff your commissary is located outside of San Joaquin County also complete section 3. <br />Business Name Las Delicias del Barrio #2 Lic. Plate* 8K54243 <br />Owner/Operator Name Miguel Valenzuela <br />Business Mailing Address 564 W Sneed rd <br />City french camp state CA Zip 95231 Bus. --Ph. 209 326 6685 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 penalties. + <br />12. To be comoleted.bv COMMISSARY OWNER/OPERATOR: I <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 pAN;: <br />[Wastewater disposal I511/3 -compartment sink EI Electrical hook-ups <br />Q,"S//olid waste disposal T Food preparation Toilet and handwashing <br />EY/Hot & Cold water for cleaning 13/E tore refrigerated food jla PP table water <br />E Store dry food/supplies IZ Overnight parking Q Vehicle 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 />commissary owrjer shall tify the EHD immalately. <br />3. To be cornpleted'b . the ENV HEALTH orisdiction 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 />I T�:61 <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 I www.sjgov.orgiehd . <br />