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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 />SAN JOAQUIN Environmental Health Department <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 EL GALLITO Lic. Plate # 6N07997 <br />Owner/Operator Name ALEJANDRO OCHOA <br />Business Mailing Address 831 S HINKLEY AVE <br />City STOCKTON State CA Zip 95215 Bus. Ph. 209)9221352 Alt. Ph. <br />(yid fid/ I 6 h 61; , 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 n (j [71/ ( 4 j <br /> <br />Date 3/21/2024 <br /> <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash FA# 209-464-9707 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />2 Wastewater disposal 12 3-compartment sink 12 Electrical hook-ups <br />EI Solid waste disposal CZ Food preparation 12 Toilet and handwashing <br />12i Hot & Cold water for cleaning er Store refrigerated food 13 Potable water <br />Et ore dry d/suppilies CT Overnight parking 13 Vehicle wash <br />I, f' NI ,hereby state that the information I have provided is current, true and <br />co o 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 o ner shal otify the EHD i mediately. <br />Signature <br /> <br />Date 3/21/2024 <br /> <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. I <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 />RENS 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 />R2 osZ352_ <br />Bus. Phone 209-271-1741 Address 730 S California St