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SANAUNp <br /> Environmental Health Department <br /> —COUNTY— <br /> Greatness grows here, <br /> COMMISSARY AGREEMENT <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 /> T. Tib.'W conn Iidted b;` PRL <br /> Business Name Tacos EI Autlense Lic. Plate# 8P93185 <br /> Owner/Operator Name Ramiro Rodriguez Gonzales <br /> Business Mailing Address 1457 S San Joaqiun Steet <br /> City Stockton State CA Zip 95206 Bus. Ph. (209)922-3691 Alt. Ph. <br /> I, Ramiro Rodriquez Gonzales 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 cont <br /> ' inued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation a enalties. <br /> Signature �/;4 .) 2- - '' Date 12/22/22 <br /> 2. Tobe com feted b, COM:MI.SSARY OWNER/OPERATOR .t' <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 17 3-compartment sink GZ Electrical hook-ups <br /> 6 Solid waste disposal 12 Food preparation 17 Toilet and handwashing <br /> ® Hot & Cold water for cleaning M Store refrigerated food Er Potable water <br /> ® Store dry food/supplies G Overnight parking U Vehicle wash <br /> Salvador Buenrostro <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 cinp, with t e con 'tions of this a ement, or if this a reement is modified or cancelled, the <br /> commissa ow notif the immediate <br /> p 9 <br /> commissary 12/22/22 <br /> Signature //i1/l� Date <br /> 3. To be com"feted by the ENV HEALTH jurisdiction`6utside"of San Joaquin Co <br /> 41 <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 e <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 />