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SAN JOAQUIN <br /> <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 />[ 1. To be completed by APPLICANT <br />Business Name Lonchera Hidalgo Lic. Plate # 7G58134 <br />Owner/Operator Name Martha Patricia Hidalgo Aguelle <br />Business Mailing Address 225 W Benjamin Holt Dr. <br />City Stockton StateCA Zip 95207 Bus. Ph. 209-271-0156 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 />Signaturc, <br />, k \ c, cde. Date 3/20/24 <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 Bus. Phone 209-271-1741 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />pt Wastewater disposal <br /> 12 3-compartment sink <br /> Et Electrical hook-ups <br />B. Solid waste disposal <br /> <br />GI Food preparation <br /> 12 Toilet and handwashing <br />Hot & Cold water for cleaning <br /> Er Store refrigerated food <br /> 13* Potable water <br />E.4 Store dry food/supplies <br /> ET Overnight parking <br /> 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 c mply with conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary ow shall noti y t e EHD immediately. <br />Signature Date 3/20/24 <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 I www.sjgov.org/ehd <br />Po9-1 1205 <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203