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SAN JOAQUIN Environmental Health Department <br /> 44Aa� —COUNTY—­ <br /> P, Greatness grOnc i--rP. <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility 1, Caterer <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> i 1 . To be Completed by Af'PLICM NT,' <br /> Business Name Tacos Rey Azteca Lic. Plate# 5R34363 <br /> Owner/Operator Name Espinoza Quinones Hector A <br /> Business Mailing Address 10431 Golf Greens Ln <br /> City Stockton State CA Zip 95209 Bus. Ph. 209 715 9560 Alt. Ph. <br /> 1,41"'J" hereby state that the above information is current,true and correct to <br /> thi 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 /> Signature 1 jr',c 77Y' LC <br /> Date 10/13/2021 <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 /> 0-<astewater disposal compartment sink 0"Electrical hook-ups <br /> olid waste disposal ErFood preparation IfToilet and handwashing <br /> CrFiot& Cold water for cleaning More refrigerated food 0"P�otable water <br /> ,tore dry food/supplies �vernight parking 0 Vehicle wash <br /> I, Salvador Buenrostro , 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 omply wit the conditions of this regiment, or if this agreement is modified or cancelled, the <br /> commissary n r shall no i the EHD immediatel; <br /> Signature I Date 10/13/2021 <br /> 3 To t d stat tea. r #�*� u <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 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />