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xSQ }�QaQQ�!N Environmental Health Department <br /> —COUNTY— <br /> Greatness grows bens. SALVADOR BUENROSTRO <br /> DBA CAUFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON,CA9WO3 <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 /> b, leted b APPLICANT; <br /> Business Name TACOS CATRINA Lic. Plate# 5D91140 <br /> Owner/Operator Name YESENIA MORALES <br /> Business Mailing Address 1030 S HUNCHIS ST STE 4245 <br /> City LODI State CA Zip 95240 Bus. Ph. 209/3958941 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 pe allies. <br /> Signature Date 11/18/22 <br /> r <br /> 2. To be tom leted b COMMISSARY OWNER/OPERAT <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 /> [a Wastewater disposal iZ 3-compartment sink 12' Electrical hook-ups <br /> 6 Solid waste disposal Et Food preparation Gr Toilet and handwashing <br /> H Hot & Coldwater for cleaning 17 Store refrigerated food Er Potable water <br /> H Store dry food/supplies 17 Overnight parking Q 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 oner shall notify the EHD imm lately. <br /> Signature Date 11/18/22 <br /> 3. To be com feted ,b 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 />