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El 3-compartment sink <br />Food preparation <br />Store refrigerated food <br />Overnight parking <br /> , hereby state that the information <br />El Electrical hook-ups <br />El Toilet and handwashing <br />rzi Potable water <br />15 Vehicle wash <br />I have provided is current, true and <br />SAN JOAQUIN <br />COUNTY <br />(.n eatness grows her ,. <br />Environmental Health Department <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 />To be completed by APPLICANT <br />Business Name Reynozo Food Truck LLC Lic. Plate #632931-3 <br /> <br />Owner/Operator Name Eduardo Reynozo <br />Business Mailing Address 1015 W 9th St Apt 1 <br />City Tracy State CA Zip 9576 Bus. Ph. (925) 960-5441 Alt. Ph. <br />1, Eduardo Reynozo ,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 <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name Max's Kitchen LLC FA# <br />City Modesto <br /> <br />zip 95351 <br /> <br />Owner/Operator William Berkowitz <br /> <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />I, Mark Luis Cruz <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 halI notify the EHD immediately. <br /> Date <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />The commissary is located in StalAIS ak,A) 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. PI ase notify EHD if e status of their operating permit changes. <br />Date 3) ZD z.4 <br />1868 E. Hazelton Avenue I Stockton, California 95205 I 1 209 468-3420 I F 209 464-0138 I wwvv.sjgov.orgiehd <br />Bus. Phone (209) 338-3663 <br />Signature <br />REHS Signature 0,1,44.e <br />Address 1211 S 7th Street