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a SAN:JOAQUIN Department <br /> Environmental Health De <br /> LAF —COUNTY— <br /> Greatness grows here. <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S COMMISSARY AGREEMENT STOCKTON CA 203 <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 /> Business Name Frutas y botanas Sol y Mia Lic. Plate# 4UJ1451 <br /> Owner/Operator Name FERNANDOANGUTANO <br /> Business Mailing Address 227 N ORO AVE <br /> City STOCKTON StateCA Zip 95215 Bus. Ph. 2095942122 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..n <br /> Signature d Date 9/29/22 <br /> 2. To be com leted :b: .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 Q' 3-compartment sink 17 Electrical hook-ups <br /> H Solid waste disposal U Food preparation 12 Toilet and handwashing <br /> 0 Hot & Cold water for cleaning M Store refrigerated food 17 Potable water <br /> E3 Store dry food/supplies EF Overnight parking EF 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 ower shal notify the EHD imm i tely. <br /> Signature Date 9/29/22 <br /> 3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin`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 />