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SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING,TRUCK WASH <br /> 730 S O <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 /> 1. To be com leted by APPLICANT <br /> Business Name Maggy's Kitchen Lic. Plate# 88903E3 <br /> Owner/Operator Name Maria Magdalena Orozco <br /> Business Mailing Address 2302 William Moss Blvd <br /> City Stockton/I State CA Zip95206 Bus. Ph. 925 639 4974 Alt. Ph. <br /> LMc. ,, , llt,� I e ,( 1yt)Z D, 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 /> SignaturtSZ� t.�ti�.z � Date 4/22/22 <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 209 464 9707 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro <br /> Check all appropriate services provided: <br /> /Wastewater disposal /3-compartment sink ­�Electricalhook-ups <br /> Solid waste disposal Food preparation Toilet and handwashing <br /> Hot& Cold water for cleaning Store refrigerated food /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 /> commissa wrier sall notify the EHD imm ialely. <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 />