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SANAAQUIN <br />COUNTY— <br />Greotness grows here. <br />Environmental Health Department <br />SALVADOR BUENROSTRO <br />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 Tacos El Chalan <br />Owner/Operator Name Jose Luciano Ordinola <br />Business Mailing Address 508 E. Lodi Ave <br /> <br />Lic. Plate # 4635778 <br /> <br />Maria Aneli Flores <br /> <br />City Lodi State CA Zip 95240 Bus. Ph. 916-541-7734 Alt. Ph. 209-331-9451 <br /> , 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 must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. <br />Signature Date 2/22/23 <br />Commissary Name California Catering Truck Wash FA# 209-464-9707 <br />Bus. Phone 209-271-1741 Address 730 S California St <br />City Stockton Zip 95203 Owner/Operator <br />Check all appropriate services provided: <br />Salvador Buenrostro & Carmen Rivera <br />E3 Wastewater disposal <br /> <br />12 3-compartment sink <br /> 12 Electrical hook-ups <br />Er Solid waste disposal <br /> <br />CZ Food preparation CI' Toilet and handwashing <br />E3 Hot & Cold water for cleaning 13 Store refrigerated food <br /> • Potable water <br />E3 Store dry food/supplies <br />13 Overnight parking 13 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 ow er shall nify the EHD immediat y. <br />Signature <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 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />Date 2/22/23