Laserfiche WebLink
SAN JOAOUIN <br />— COUNTY <br />iately. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WAS 730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />Environmental Health Department <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 460168Y2 <br /> <br />City Lodi State CA Zip 95240 Bus. Ph. 2096841591 Alt. Ph. 2095689061 <br />(;) 1)GV\ 2..o L-t7 Z.— , hereby state that the above information is current, true and correct to <br />the best of my knowledge an 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 dj ctirnle the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation ancl-penaltie. ) <br />Signature Date 5/15/23 C <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 />Fa Wastewater disposal <br /> <br />Er 3-compartment sink <br /> <br />ra Electrical hook-ups <br />EI Solid waste disposal <br /> El Food preparation <br /> Et Toilet and handwashing <br />Et Hot & Cold water for cleaning <br /> Er Store refrigerated food <br /> Et Potable water <br />EI Store dry food/supplies <br /> Er 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 />1, <br />commissar <br />Signature <br />wner sha notify the EHD im <br />\t (WM 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 1 209 468-3420 I F 209 464-0138 I www.sjgov.orgiehd