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SAN JOAQUIN Environmental Health Department <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 />11. To be completed by APPLICANT <br />Business Name Tacos Meno Lic. Plate # 83592D1 <br />Owner/Operator Name Manuel Vazquez <br />Business Mailing Address 19370 W Grant line rd <br />City Mountain house State CA Zip 95391 Bus. Ph. 925 339 6421 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 discostinuedi the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. I <br />12. To be completed by 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 provided <br />if Wastewater disposal .0' -3 -compartment sink IlElectrical hook-ups <br />Solid waste disposal dFood preparation $-Toilet and handwashing <br />Or Hot & Cold water for cleaning ❑ tore refrigerated food O'Potable water <br />❑ Store dry food/supplies ❑ Overnight parking ;YV''ehie 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 />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 <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 />