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SAN JOAQUIN Environmental Health Department <br /> COUNTY <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT <br /> 730 CKTON cA 5 03 <br /> Mobile Food Facility o Caterer <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> 1 . To be completed by APPLICANT <br /> Business Name Hong Nhung Chinese Food Lic. Plate# 4JM7826 <br /> Owner/Operator Name Jian Ouyang <br /> Business Mailing Address 2733 North Hunter St <br /> City Stockton StateCA Zip 95204 Bus. Ph. 209-298-2385 Alt. Ph. <br /> I, Jian Ouyang , 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 penalties. <br /> Signature qKI- U Date 3/6/23 <br /> 2. To be completecYby CO ISSARY 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 /> Ca Wastewater disposal Ck 3-compartment sink Ck Electrical hook-ups <br /> • Solid waste disposal [2 Food preparation Q' Toilet and handwashing <br /> • Hot & Cold water for cleaning Q' Store refrigerated food 13 Potable water <br /> H Store dry food/supplies 17 Overnight parking Gr 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 /> commissa caner shall notify the EHD imm ate y. <br /> Signature Date 3/6/23 <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 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 />