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SHAUNEnvironmental Health Department <br /> `a <br /> —COUNTY— SALVADOR BUENROSTRO <br /> �5+ crPatn-ss growhest.. DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> STOCKTON,CA 95203 <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility♦ Caterer <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> l . To lie completed ,, PLIGANT <br /> Business Name Charly's Suaer Tortas Chilangas <br /> Lic. Plate# 4RS5610 <br /> Owner/Operator Name Brenda Lo ez - Serrano <br /> Business Mailing Address 350 Horton Ave <br /> City STOCKTON State CA Zip 95206 Bus. Ph. (916) 346-9828 Alt. Ph. (916) 346-6668 <br /> , 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 penal ' <br /> Date 11108/22 <br /> Signature <br /> 2. To. . d .n Q, ._ , - AR`( OW"'e")PERA I <br /> CommissaryName California Caterin Truck Wash <br /> FA# 209-464-9707 <br /> Address 730 S California St Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> 2 Wastewater disposal 17 3-compartment sink Gr Electrical hook-ups <br /> 6 Solid waste disposal Gd' Food preparation <br /> M Toilet and handwashing <br /> 0 Hot& Cold water for cleaning 0' Store refrigerated food a Potable water <br /> 0 Store dry food/supplies U Overnight parking <br /> [3 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 /> commissa wner sh II notify the EHD im diately. <br /> Date 11/08/22 <br /> Signature <br /> al Tla Ittris ctioh o a si' 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 /> Date <br /> REHS Signature <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 />