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SAN JOAQUIN Environmental Health Department <br /> SALVADOR SUENROSTRO <br /> DBA CALIFO8 CATERING <br /> N A SUCK WASH <br /> 0 <br /> COMMISSARY AGREEMENT STOCKrON,CA952o3 <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 Tacos Magda Lie. Plate# 4UL7998 <br /> Owner/Operator Name Magda Elizabeth Sandoval <br /> Business Mailing Address 1718 E 13th St <br /> City Stockton State CAZip 95206 Bus. Ph. 209 610 4215 Alt. Ph. 408 472 0485 <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. 1 <br /> Signature vc-Ayl J V I ( �- Date 7/7/22 <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 209 464 970 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro <br /> Check all appropriate services provided: <br /> M( Wastewater disposal 3-compartment sink 0"'Electrical hook-ups <br /> W/solid waste disposal O/Food preparation dToilet and handwashing <br /> C7' Hot & Cold water for cleaning Store refrigerated food Potable water <br /> I�Store dry food/supplies Overnight parking Y Vehicle 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 /> commissary caner sFfall notify the EHD imrpediately. <br /> '`' i Date 7/7/22 <br /> Signature <br /> 3. To be 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 209 468-34201 F 209 464-0138 i %%ww.sjgov.org'ehd <br />