Laserfiche WebLink
SAN,JOAQUIN Environmental'Realth Department <br />--- COU i ,, i SALVADOR RUFNROSTRO <br />DSA CAUFOhinir: ;,p i THING TRUCK WASH <br />�. nta tnt;;s <br />730 $ C%.HUFORNIA ST <br />$TOCKTON, 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 />l . To be -completed by APPLICANT <br />Business Name Mikey's Lic. Plate # 4SG4557 <br />Owner/Operator Name Miguel Ventura <br />Business Mailing Address 1844 S Calfornia St <br />City Stockton State CA Zip 95206 Bus. Ph. 209 518: 7014 Alt. Ph. <br />/ y <br />I, , hereby state that the above information is current, true and correct to <br />the b t 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 penalties. I <br />2. To be com feted by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FA# <br />Address 730 S California ST Bus. Phone <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro <br />Check all appropriate services provided: <br />('Wastewater disposal EY3-compartment sink Electrical hook-ups <br />.i( Solid waste disposal []�FOOd preparation Gk -Toilet and handwashing <br />Er Hot & Cold water for cleaning Ei Store refrigerated food a Potable water <br />Q'�Store dry food/supplies O Overnight parking 0 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°Lwner shall notify the EHD immediately. <br />Signature1\fk .Uq 0 \AA.itM Date 7/13/22 <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin 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 />REHS <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 />V V05"`��Ic�� <br />