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Date Gel"' <br />revocation and pen flies. <br />Signature 07/(91 <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <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 El Mayita Tacos y Birria #6 Lic. Plate # <br />Owner/Operator Name Luis Ernesto Saavedra Cadena <br />Business Mailing Address 417 Ryder Way <br />City Modesto <br /> <br />State CA Zip 95351 Bus. Ph. (510)331-9066 Alt. Ph. <br /> <br />Luis Ernesto Saavedra Cadena , 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 discon inued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash <br />Address 730 S. California St <br /> Bus. Phone (209)271-1741 <br />FA# <br />City Stockton zip 95203 Owner/Operator Salvador Buenrostro <br />Check all appropriate services provided: <br />El Wastewater disposal <br /> <br />El 3-compartment sink <br /> <br />El Electrical hook-ups <br />121 Solid waste disposal <br /> EJ Food preparation In Toilet and handwashing <br />El Hot & Cold water for cleaning El Store refrigerated food <br /> <br />El Potable water <br />El Store dry food/supplies El Overnight parking 0 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 />1/0 - VIA1114 WA) /E <br />commissary owner shall notify the EHD immedia I <br />Date <br /> <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 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />I, Salvador Buenrostro <br />Signature