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SAN.JOAQUIN Environmental Health Department <br /> ---COUNTY-- <br /> ;:e: r grows F�em SALVADOR BUENROSTRO <br /> JBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON, A 95203 <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 completedby APPLICANT <br /> Business Name EI Chilteain Lic. Plate# 75421 M1 <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) requirements. If the use of the <br /> commissary is discontinued,the permit hol 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 /> Wastewater disposal G7 3-compartment sink 12 Electrical hook-ups <br /> H Solid waste disposal 17 Food preparation GY Toilet and handwashing <br /> H Hot& Cold water for cleaning U Store refrigerated food 17 Potable water <br /> H Store dry food/supplies M Overnight parking G 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 er shall otify the EHD immedia ly, <br /> Signature Date 8/3/22 <br /> 3. To be t.otn feted by the ENV1 HEALTH jurisdiction outside of in 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 1 www.sjgov.org/ehd <br />