Laserfiche WebLink
5 ,° MUIN Environmental Health Department <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON, CA 95203 <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 3 Amigas Pupuseria Lic. Plate#4VK2478 <br /> Owner/Operator Name Lillian Marquez/Karla Lopez Saguero <br /> Business Mailing Address 4413 Mist Trail Dr. <br /> City Stockton State CA Zip 95206 Bus. Ph. 209-641-4346 Alt. Ph. 209-455-5873 <br /> be hereby state that the above information is current,true and correct to <br /> theb tse of my knowledgiA 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 discon ued,the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> A- <br /> revocation SignatureDate11/27/23 <br /> 2. To b 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 /> 12 Wastewater disposal 12 3-compartment sink Ck Electrical hook-ups <br /> rd Solid waste disposal 1' Food preparation Qf Toilet and handwashing <br /> Q Hot & Cold water for cleaning 17 Store refrigerated food (7 Potable water <br /> E3 Store dry food/lies D' Overnight parking G Vehicle wash <br /> I, OCAV vviefi , 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 /> commissary oviner sheKI notify the EHD immed' ely. <br /> Date 11/27/23 <br /> Signature <br /> 3. To be com leted 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 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />