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SAN JOAQUIN Environmental Health Department <br /> ---COUNTY-- - <br /> Grcarncr, �rOws F. <br /> SALVADOR BUENROSTRO <br /> OBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CAO�ORNI[A ST <br /> COMMISSARY AGREEMENT STOCK1ON, A 95203 <br /> Mobile Food Facility s Caterer <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> ?. To ie completed bAPPLICANT <br /> Business Name EI Chiltepin Lic.Plate# 75421M1 <br /> Owner/Operator Name Pedro Alarcon <br /> Business Mailing Address 4486 Continental Way <br /> City Stockton StateCA Zip 95207 Bus. Ph. 209 244 0381 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) requlrements. If the use of the <br /> commissary is discontinued,the permit hof er must notify the EHD. Failure to notify this office may result in permit <br /> revocation and penalties. <br /> Signature Date 8/3/22 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <br /> Commissary Name California Catering Truck Wash FA# 209-464-9707 <br /> Address 730 S California St Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> 12 Wastewater disposal G1 3-compartment sink U Electrical hook-ups <br /> fa Solid waste disposal 12 Food preparation 9 Toilet and handwashing <br /> H Hot& Cold water for cleaning Cf' Store refrigerated food G Potable water <br /> H Store dry food/supplies Q Overnight parking U 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 /> commissaryer shall otify the EHD immedia ly. <br /> Signature Date 8/3/22 <br /> 3. To be corn leted by the ENV HEALTH:'urisdiction outside of SnjO WC <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 952051 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br />