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SQNsJQQQUIN Environmental Health Department <br /> 5 <br /> —COUNTY <br /> re�ftte5s yaws afire. SALVADOR 13UENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA 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 /> 1 . To be com , "APPLICANT <br /> Business Name Resunga 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, hereby state that the above information is current,true and correct to <br /> the best afziify cnowledge 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 penalties. <br /> Signature Date 12/1/22 <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 /> 12 Wastewater disposal 17 3-compartment sink G1 Electrical hook-ups <br /> H Solid waste disposal Q' Food preparation 0' Toilet and handwashing <br /> ® Hot & Cold water for cleaning CCS' Store refrigerated food 17 Potable water <br /> H Store dry food/supplies G' Overnight parking 17 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 er shalltify the EHD immedia e . <br /> SignatureOo Date 12/1/22 <br /> 3. To be completed b` the ENV HEALTH jurisdiction'outsi a uln`C6` <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 />