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Environmental Health Department <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON;CA95203 <br /> Mobile Food Facility Caterer <br /> Complete sections f 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 TACOSTENO Lic. Plate# 6M19866 <br /> Owner/Operator Name CESAR CORTEZ <br /> Business Mailing Address 2325 FRASER AVE <br /> City STOCKTON State CAZip 95204 Bus. Ph. 2095073492 Alt. Ph. <br /> I, C4 N V 17AlAfr?, , 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 t Date 4/22/22 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <br /> Commissary Name . California Catering Truck Wash FA# 2094649707 <br /> Address 730 S CALIFORNIA ST Bus. Phone 2093903712 <br /> City STOCKTON Zip 95203 Owner/Operator SALVADOR BUENROSTRO <br /> Check all appropriate services provided: <br /> Wastewater disposal 1*13-compartment sink Electrical hook-ups <br /> ./Solid waste disposal Food preparation /Toilet and handwashing <br /> Hot& Cold water for cleaning /Store refrigerated food i Potable water <br /> Store dry food/supplies ✓ Overnight parking Vehicle wash <br /> I, hereby stale 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 /> commissary er shenotify the EHD imme tely. <br /> Signature Date 4/22/22 <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 />