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SHAUN Environmental Health Department <br /> 9 A --COU NTY-- <br /> a., Greatn#ss grow.€ here, <br /> SALVADOR BUENROSTRO <br /> ATERING <br /> COMMISSARY AGREEMENT OBACAU733 Ns ALFOR ST TRUCK wasH <br /> STOCKTON,CA 85203 <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 completoo& <br /> Business Name SantaMaria Lic. Plate# 4TWJ868 <br /> Owner/Operator Name Israel Encaracion Castaneda <br /> Business Mailing Address 150 Gateway Ct Apt 3 <br /> City Stockton State CAZip 95207 Bus. Ph. 209 430 2883 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 Date 8/30/22 <br /> 2. Tobe com feted b. -COMMISSARY OWNER/OPERATOR 1111111111111110 1 <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 /> 13 Wastewater disposal U 3-compartment sink Gr Electrical hook-ups <br /> 6 Solid waste disposal U Food preparation Q Toilet and handwashing <br /> H Hot & Cold water for cleaning R Store refrigerated food Q Potable water <br /> ® Store dry food/supplies EF Overnight parking W 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 /> commissa caner isII notify the EHD imm diately. /� <br /> Signature T 1 N i IN Date 8/30/22 <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, Califomia 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />