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SAN JOAQUIN Environmental Health Department <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S A ST <br /> COMMISSARY AGREEMENT STOCKTON,OCA95 03 <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 DELICIAS BRANDY Lic. Plate# 4LU8236 <br /> Owner/Operator Name ANDRES VALENCIA <br /> Business Mailing Address 1367 FLINT WAY <br /> City y �1 �LState CAZip 94533 Bus. Ph. 707)3848513 Alt. Ph. <br /> I hereby state that the above information is current, true and correct to <br /> the best of m nowledge and agree to utilize my approved commissary in accordance with California Health & <br /> Safety Code, a San Joaquin County Environmental Health Department (EHD) requirements. If the use of the <br /> commissa ' d ontinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation n p Ities. <br /> Signature Date 3/28/2024 <br /> 2. To be I ted by COMMISSARY OWNER/OPERATOR <br /> Commissary Nam 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 /> U Wastewater disposal [2 3-compartment sink 12 Electrical hook-ups <br /> L7 Solid waste disposal 11 Food preparation 12 Toilet and handwashing <br /> E3 Hot & Cold water for cleaning 11 Store refrigerated food 9 Potable water <br /> 0 Store dry food/supplies G Overnight parking 13 Vehicle wash <br /> 1, , 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 taihsoomLInotify <br /> the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> commissar s the EHDmediatelly. <br /> Signature �l VaiAA1V ©ate 3/28/2024 _ <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 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br /> ��2pSygD(�- <br />