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SAN.JOAQUIN Environmental Health Department <br /> —COUNTY— <br /> SALVADOR BUENROSTRO <br /> Greutn?s> avows here. DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALIFORNIA ST <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 /> [17T be completed by APPLICANT" <br /> Business Name CREPETEA CO. Lic. Plate# 4KJ9730 <br /> Owner/Operator Name TAMTHANH TRAN <br /> Business Mailing Address 7554 PACIFIC AVE. #2012 PO BOX 692012 <br /> City STOCKTON State CAZip 95203 Bus. Ph. 2092006190 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 4 f Date 5/26/22 <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 <br /> City Stockton Zip 95203 Owner/Operator Salvador BUENROSTRO <br /> Check all appropriate services provided: <br /> ❑ astewater disposal W3-compartment sink Electrical hook-ups <br /> Solid waste disposal food preparation 0 Toilet and handwashing <br /> gl'Hot & Cold water for cleaning �St re refrigerated food OrPotable water <br /> Li' Store dry food/supplies Overnight parking qXehicle 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 a reement, or if this agreement is modified or cancelled, the <br /> commissary Vir shall noff� the EHD immediate)0 <br /> Signatur( I _ I 1 Date 5/26/22 <br /> 3. Tobe completed by the ENV HEALTH jurisdiction outside of San'Joa uin 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 />