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s A Kpi 0 A u IN <br />—COUNTY— <br />,. Greotness grows here. .) <br />Environmental Health Department <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT STOCKTON, 0A95203 <br />730 S CALFORNIA ST <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 />,•1 <br />ISH & IS GOURMET FOOD Lic. Plate # 23824A3 Business Name <br />Owner/Operator Name WILLIAM ALFONSO BREED <br />Business Mailing Address P 0 BOX 580375 <br />City ELK GROVE State CA Zip 95758 Bus. Ph. 2092236461 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 (END) requirements. If the use of the <br />commissary is disconti ued, the permit holder must notify the END. Failure to notify this office may result in permit <br />revocation and nalti <br />Date 2/28/23 Signature <br />Yqr4 -4 r• 0Ji <br />( et 016 ", <br />raW, A ;0111#111% .r.r:Ota vkieR <br /> <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <br /> <br />FA# 209-464-9707 <br /> <br />Bus. Phone 209-271-1741 <br /> <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> <br />Check all appropriate services provided: <br />at Wastewater disposal <br /> CI 3-compartment sink <br /> 12 Electrical hook-ups <br />Ef Solid waste disposal <br /> Er Food preparation <br /> rz Toilet and handwashing <br />Hot & Cold water for cleaning <br /> Et Store refrigerated food <br /> la Potable water <br />Store dry food/supplies <br /> El Overnight parking <br /> Er 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 o %trier shall rQtify the END imme ely. <br />Signature <br /> <br />IAA,VL <br /> <br />Date 2/2823 <br /> <br />eeqf'%' <br /> <br />r. -4 !-5A140miefitsc <br /> <br />eff41- <br /> <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