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RECEINTSAN JOAQUIN Environmental Health Department <br />SALVADOR BUENROSTRO <br />MAR Z 4 2O ? DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />ISN IIZONNIEN IAI, Ill 1i f It COMMISSARY AGREEMENT <br />D;,Vk ZI'VILN I 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 EI Autlense Lic. Plate # 1X95456 <br />Owner/Operator Name Vizcaino Ernesto Hernandez <br />Business Mailing Address 1457 S San Joaquin St <br />City Stockton State CA Zip 95206 Bus. Ph./f) %1), '0 H Alt. Ph. <br />M, %� `�j hereby state that the above information is current, true and correct to <br />the best ooff�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 />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St Bus. Phone (209) 271-1741 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro <br />Check all appropriate services provided: <br />Wastewater disposal B'3 -compartment sink Girtlectrical hook-ups <br />e -Solid waste disposal Cr -Food preparation LYroilet and handwashing <br />C�Hot & Cold water for cleaning C9 SStore refrigerated food Pr Potable water <br />torp dry food/supplies n E Overnight parking CKVehicle wash <br />I,, hereby slate that the information I have provided is current, true and <br />corre t best o mowledge, an 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 />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 F. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />