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t' ,',, SAUOAQUIN Environmental Health Department <br />i <br />—COUNTY—– <br />"re l Gir+.'oknpss grrpws lief B. <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 />1. To completed, bAPPLICANT <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 5206 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 Pcontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation a enalties. <br />_. pe <br />i✓A7 '*�M ) L 12/22/22 <br />2. To be completed by 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 />la Wastewater disposal U 3 -compartment sink 12 Electrical hook-ups <br />6 Solid waste disposal d' Food preparation EX Toilet and handwashing <br />® Hot & Coldwater for cleaning 17 Store refrigerated food 17 Potable water <br />® Store dry food/supplies 17 Overnight parking 17 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 c pl with t e con 'tions of this a eement, or if this agreement is modified or cancelled, the <br />commissa ow s noti the immediate <br />Signature i /fi1/l Date 12/22/22 <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joa uin 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 />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />