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SHAUN Environmental Health Department <br />COUNTY— <br />Greatness grows herr. <br />SALVADOR BUENROSTRO <br />JbA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT TOCKTo CA 520 <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 completed by APPLICANT ma <br />Business <br />Owner/OF <br />Plate #. IpVV(R7W <br />Business Mailing Address l I V I C, I"1p,f'GAt, L.).,I. J%1 +< Cn <br />City S_ -E OCjL+QM State(�Zip QS210 Bus. Ph.701-'nLf - 129'S Alt. Ph.uxi -Zlog 'OoZ S <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 />t;necK all appropriate services provided:: <br />wastewater disposal C 3 -compartment sink `O Electrical hook-ups <br />f'solid waste disposal �ood preparation Toilet and handwashing <br />p trot & old water for cleaning A'Stor refrigerated food 111�Potable water <br />tore dry food/supplies Overnight parking 13 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 agreemen is modified or cancelled, the <br />commissary j�w/fjler shall IyaI Iptify the EHD immediat/gf]� / <br />Rinnah irp III /Ili I I n\ )IIA AAA I/{ . I .e. A n�fo <br />13. 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 <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 />