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SAN JOAQUIN Environmental Health Department <br />C C UNTY <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WAS <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 />To be completed by APPLICANT <br />Business Name Tacos El Chaparro <br />Owner/Operator Name Juan Rodrigues <br />Business Mailing Address N. Highway 99 Spc. 74 <br /> <br />Lic. Plate #60168Y2 <br /> <br />City Lodi State CA Zip 95240 Bus. Ph. 2096841591 Alt. Ph. 2095689061 <br />,),„ „c) „0„,_ , 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 disc e the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation ap,c1 enaltie§, • ) <br />Signature QV' kr" Date 5/15/23 <br />To ompleted by COMMISSARY OWNER/OPERATOR <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 />Et Wastewater disposal <br />El Solid waste disposal <br />El Hot & Cold water for cleaning <br />E3 Store dry food/supplies <br />El 3-compartment sink <br />CZ Food preparation <br />Store refrigerated food <br />ET Overnight parking <br />La Electrical hook-ups <br />D' Toilet and handwashing <br />GI Potable water <br />12 Vehicle wash <br />I, ,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 wner shaj4 notify the EHD imr1Qdiately. <br />Signature - '\11(W1/44/1 Date 5/15/23 <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