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�� SAN.�I�AQUIN Environmental Health Department <br /> f C O U N T Y SALVADOR BUENROSTRO <br /> ' + <br /> 1•_X/ Greatness grows here. DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> STOCKTON, CA 95203 <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 /> Business Name Delicias de Rincon Lic. Plate# 8A46711 <br /> Owner/Operator Name David Rodriquez Gutierrez <br /> Business Mailing Address 1521 Faye Street <br /> City Stockton State CA Zip 95206 Bus. Ph. 209-981-1595 Alt. Ph. <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 /> revocation and pen <br /> Signature - � Date 1/23/23 <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 /> Q Wastewater disposal 12 3-compartment sink 12 Electrical hook-ups <br /> B Solid waste disposal 12 Food preparation 12 Toilet and handwashing <br /> 0 Hot & Cold water for cleaning ®' Store refrigerated food ICS Potable water <br /> 0 Store dry food/supplies Q Overnight parking IS 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 owner shall notify the EHD i ediateI . <br /> Signature Date 1/23/23 <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 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />