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=c' SANs10AQUIN <br /> Environmental Health Department <br /> 1� —COUNTY— <br /> �°i <br /> Greatness grows hart. SALVADOR BUENROSTRO <br /> DBA CAUFORNIA CATERING TRUCK WASH <br /> 730 S CALIFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON,CA 95203 <br /> Mobile Food Facility • Caterer <br /> Complete sections f and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> Business Name Resunoa momo & curry Lic.Plate# 87975F3 <br /> Owner/Operator Name RAJ KUMAR SHREEPALI <br /> Business Mailing Address 16201 S. HARLAND RD <br /> City LATHROP State CA Zip 95230 Bus. Ph. 4087979305 Alt. Ph. <br /> I, <br /> ,hereby state that the above information is current,true and correct to <br /> the best cnowledge and agree to utll¢e 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. ^ ,. <br /> Signature Date 12/1/22 <br /> Commissary Name <br /> __California CateringTruck 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 /> U Wastewater disposal U 3-compartment sink U Electrical hook-ups <br /> B Solid waste disposal 67 Food preparation Q Toilet and handwashing <br /> H Hot& Cold water for cleaning Cid' Store refrigerated food M Potable water <br /> H Store dry food/supplies G Overnight parking 17 Vehicle wash <br /> , 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 er shall tify the EHD immedia e . <br /> Signature A AA. V IA44A Date 12/1/22 <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 />