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Signature <br />3*-ifolb&e®. roJ in@aNtm - <br />Date 9/22/22 <br />ea ' <br />1, <br />,• SAN)J OA Q U IN <br />—COU NTY— ,t <br />Greottv,.ss fVVi.i hete. <br />Environmental Health Department <br />SALVADOR SUENROSTRO DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA WASH 730 AGREEMENT <br />Mobile Food Facility + Caterer STOCKTON, CA 95203 <br />••• <br />Complete sections 1 and 2. If your commissaty is located outside of San Joaquin County also complete section3. <br />saemaattLaT • <br />Business Name LA BOMBONERA <br />Owner/Operator Name HECTOR ALMAZAN <br />Business Mailing Address 2379 E LINDSAY ST PO BOX 55193 <br />City Stockton State CAZip 95205 Bus. Ph. 209 8981949 Alt. Ph. <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 holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and pe It' s. <br />Signature <br /> <br />Date 9/22/22 <br /> <br />IC) <br /> <br />PsibpilontIVICM <br /> <br />5°. <br /> <br />Commissary Name California Catering Truck Wash FA# 209-464-9707 <br />Lic. Plate # 4P38616 <br />Address 730 S California St <br />City Stockton Zip <br /> <br />Bus. Phone 209-271-1741 <br /> <br />95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> <br />Check all appropriate services provided: <br />igt Wastewater disposal <br />Er Solid waste disposal <br />El Hot & Cold water for cleaning <br />El Store dry food/supplies <br />12 3-compartment sink <br />r2 Food preparation <br />Er Store refrigerated food <br />Er Overnight parking <br />12 Electrical hook-ups <br />12 Toilet and handwashing <br />Er Potable water <br />17 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 />commissar, cfvner s II notify the EHD im ediately. <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