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± i ` SANAAQUIN Environmental Health Department <br />1 —COUNTY-- <br />Greatness growx here <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT STOCKTON,CA2o3 <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 />To be completed by APPLICANT <br />Business Name MMB International Cuisine Lic. Plate# 4RY8416 <br />Owner/Operator Name_Mahgoub Medhat <br />Business Mailing Address 2929 Bridge Cross Ct <br />City Stockton State CA Zip 95212 Bus. Ph. 510-459-7230 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 E�15 <br />mental Health Department (EHD) requirements. If the use of the <br />commissary is discontinued, theytermit Imono fy the EHD. Failure to notify this office may result in permit <br />revocation and penalties. / AS <br />2. To be completed by COMMISSARY OWNER/OPF_RATOR <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 />12 Wastewater disposal <br />6 Solid waste disposal <br />13 Hot & Cold water for cleaning <br />® Store dry food/supplies <br />12 3 -compartment sink <br />12 Food preparation <br />GY Store refrigerated food <br />19 Overnight parking <br />fad' Electrical hook-ups <br />12 Toilet and handwashing <br />Er Potable water <br />17 Vehicle wash <br />1, , 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 imgldiately. n <br />Signature A I n,✓"A17-A V./ iA d. A <br />3. To be completed b` 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 Sionature <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 />