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SANJOAQUIN <br /> <br />Environmental Health Department <br />--COUNTY - <br />Grcotness gro, her <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <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 Reyes <br /> <br />Lic. Plate # 4UA4363 <br /> <br />Owner/Operator Name Guadalupe Reyes Munguia <br /> <br />Business Mailing Address 1717 S Adelbert Ave <br />City Stockton State CA Zip 95215 Bus. Ph.209-910-2476 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 (EHD) requirements. If the use of the <br />commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. <br />Sig na tu r thckt 10 fi, /Y :s Date 1/15/2024 <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FA# 209-464-9707 <br />Address 730 S California St <br /> <br />Bus. Phone 209-271-1741 <br />1, <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />wei Wastewater disposal <br /> Er 3-compartment sink <br /> 12 Electrical hook-ups <br />FS Solid waste disposal <br /> Er Food preparation GI Toilet and handwashing <br />Hot & Cold water for cleaning ET Store refrigerated food <br /> <br />Ei Potable water <br />Store dry food/supplies ST Overnight parking GI 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 a reement, or if this agreement is modified or cancelled, the <br />commissary ownshall no ify the EHD immediatel 1 <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 www.sjgov.org/ehd <br />FaL <br />Signature <br /> <br />140/31 1/ba <br /> <br />Date 1/15/2024 <br />