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SAN JOAQUIN <br /> Environmental Health DepartmF:r1 <br /> ;NIY <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S STOCKTON,ORNIA ST <br /> CA 95263 <br /> COMMISSARY AGREEMENT <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 To be completed by APPLICANT <br /> Business Name DON RAFAS TACO SHOP Lic.Plate# 76401 T2 <br /> Owner/Operator Name RAFAEL CASTILLO ESTRADA <br /> Business Mailing Address 1248 E. MINER AVE <br /> City STOCKTON State CA Zip 95205 Bus. Ph. 2098298539 Alt. Ph. <br /> I. RAFAEL CASTILLO ,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 rmit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and penalties. <br /> Signature —� Date 8/10/2023 <br /> 2. To be completed by d OMMISSARY 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 /> R Wastewater disposal 12 3-compartment sink 12 Electrical hook-ups <br /> Q Solid waste disposal 9 Food preparation 12 Toilet and handwashing <br /> Fd Hot& Cold water for cleaning 19 Store refrigerated food 9 Potable water <br /> 9 Store dry food/supplies Q Overnight parking 13 Vehicle wash <br /> 1. ,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 fail to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> commissa" wrier s, I notify the EHD imm diately. <br /> Signatures Dale 8/10/2023 <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 952051 T 209 468.3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />