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commissary ner sh441\ notify the EHD imm <br />Signature <br />ately. <br />VIMA4 Date 3/23/23 <br />SANdOAQUIN <br />---COUNTY <br />Environmental Health Department <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 NameCali botanas locas el sabor mas mexicano Lic. Plate # 4VF5812 <br />Owner/Operator Name JUA CARLOS GARCIA /SELENE MENDOZA <br /> <br />Business Mailing Address 1121 OLD WHARF CT <br /> <br />City LATHROP State CA Zip Bus. Ph. 510-9093797 Alt. Ph. <br />, hereby state that the above information is current, true and correct to 1, <br />the best of my knowle <br />Safety Code, and S <br />commissary is dis <br />revocation and <br />Signature <br />ge and aree to utilize my approved commissary in accordance with California Health & <br />ounty Environmental Health Department (EHD) requirements. If the use of the <br />e permit holder must notify the EHD. Failure to notify this office may result in permit <br />Date 3/23/23 <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FA# 209-464-9707 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />Bus. Phone 209-271-1741 Address 730 S California St <br />r2 Wastewater disposal <br />Et Solid waste disposal <br />Et Hot & Cold water for cleaning <br />Store dry food/supplies <br />D' 3-compartment sink <br />D' Food preparation <br />Ef Store refrigerated food <br />Overnight parking <br />D' Electrical hook-ups <br />ri Toilet and handwashing <br />Potable water <br />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 />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