Laserfiche WebLink
Signature <br />revocation enalties. <br />Date 11/6/23 <br />'SAN JOAQUIN <br />OSL-M71 <br />Environmental Health Department <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 />1. To be completed by APPLICANT <br />Business Name The Wing Truck LLC <br />Lic. Plate # 4MP6095 <br />Owner/Operator Name Brenda Sandigo <br />Business Mailing Address 815W Longview Ave <br />Alt. Ph. <br />T , hereby state that the above information is current, true and correct to <br />the best of my knowledge d 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 />2. 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 />City Stockton State CA Zip 95207 Bus. Ph. 209-949-0810 <br />'vt,v\ce, <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />Wastewater disposal <br /> <br />0' 3-compartment sink <br /> <br />D' Electrical hook-ups <br />13 Solid waste disposal <br /> <br />12' Food preparation <br />GZ Toilet and handwashing <br />13 Hot & Cold water for cleaning <br />13 Store refrigerated food <br /> <br />ET Potable water <br />Store dry food/supplies Er Overnight parking S' 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 />commissary owner shall notify the EHD immed a ely. <br />11/6/23 <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. 1 <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.org/ehd <br />Signature Date