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SAN„JOAQUIN <br /> <br />Environmental Health Department <br />—C OU NT Y-- <br />Gr1.7otne,ss grows here. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility • Caterer <br />SALVADOR BUENROSTRO <br />IFC,RNI IA CATERING TRUCK WASH <br />.6 CALFORNIA ST <br />FOCKTON, CA 95203 <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />Business Name Ta,e4oco U p(y -16 - <br />Owner/Operator Name Brisa Mar Andrade Valdez <br /> <br />Lic. Plate # 36785B3 <br /> <br />Business Mailing Address 44 S Dawes Ave <br />City Stockton State CA Zip 95215 Bus. Ph.209-279-0156 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 />Signature Date 1/22/2024 <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 />Wastewater disposal Ur 3-compartment sink GI Electrical hook-ups <br />Er Solid waste disposal 12 Food preparation Et Toilet and handwashing <br />Hot & Cold water for cleaning Er Store refrigerated food ET Potable water <br />El Store dry food/supplies 13 Overnight parking 13 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 mply with thyonditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary owrJ shall notify h EHD immediately. <br />Signature <br /> <br />4/7A Date 1/22/2024 <br /> <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 I www.sjgov.org/ehd <br />09--\*R-33-1- <br />1,