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SANJOAOUIN Environmental Health Department <br />-- COUNTY---- , <br />.., ,rp yy - n.•re. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility a Caterer <br />Complete sections 1 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 TACOS EL RORO Lic. Plate # 66913Z1 <br />Owner/Operator Name MARIA GUADALUPE AVILA <br />Business Mailing <br />CitySTOCKTON State CA Zip 95205 Bus. Ph;[D!l b!j r)!l u HU Ph. <br />I, mayl G A V� 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; eAalties.f 1 4 1 I� <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name CALIFORNIA CATERING TRUCK WASH FA# 2094649707 <br />Address 730S. CALIFORNIA ST Bus. Phone 2092711741 <br />CitySTOCKTON Zip 95203 Owner/Operator SALVADOR BUENROSTRO <br />Check all appropriate services provided: / <br />M/Wastewater disposal -compartment sink E Electrical hook-ups <br />P"s— <br />olid waste disposal Food preparation 01 oilet and handwashing <br />Q t & Cold water for cleaning ;YSto refrigerated food p�otable water <br />t� re dry food/supplies Overnight parking Vehicle wash <br />I, , hereby state that the information I have provided is current, true and <br />cor ect. o the of my know) dge, 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 odifie or cancelled, the <br />ry <br />commissa owf er shall']�ti the EHD immediat� <br />Rinnnt res�/I IA - 1!lMVW_A ./I 1/1A A 1, nates 2 �6 <br />13. To be completed by the ENV HEALTH iurisdiction outside of San Joaquin 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.sjgov.org/ehd <br />