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SAW]OAQU{N Environmental Health Department <br /> CC)UNTY— <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 /> 1. To be completed by APPLICANT <br /> Business Name TACOS CATRINA Lic. Plate# 4UM6445 <br /> Owner/Operator Name YESENIA MORALES <br /> Business Mailing Address 1030 S. HUNCHIS ST. STE 4245 <br /> City LODI State CA Zip 95240 Bus. Ph. 2093958941 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 /> Signature Date 1/22/22 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <br /> Commissary Name CALIFORNIA CATERING TRUCK WASH FA# <br /> Address 730 S. CALIFORNIA ST Bus. Phone 2094649707 <br /> City STOCKTON Zip 95203 Owner/Operator 2092711741 <br /> Check all appropriate services provided: M" <br /> Electrical disposal 13/3-compartment sink to Electrical hook-ups <br /> )Solid waVp disposal EVIFood preparation dToilet and handwashing <br /> fd� of& Coln water for cleaning V SS re refrigerated food dPotable water <br /> Store dry food/supplies B Overnight parking Vehicle wash <br /> I, hereby state that the information I have provided is current,true and <br /> correctto the best of my knowledge,and meets the California Health&Safety Code requirements. If the food facility <br /> operator falls to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> commissaryernnshall n tify the EHD immedia <br /> Signature 11A ' Y Mme- Date 01/22/22 <br /> .. � (`" - <br /> 3. To be completed by the ENV HEALTH jurisdiction 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 /> 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 />