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pi?osq qo <br /> ::I- <br /> SAN JOAQUIN Environmental Health Department <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S ST <br /> COMMISSARY AGREEMENT STOCKTON,OCA9S 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 /> CityY�j �� State CAzip94533 Bus. Ph. 707)3848513 Alt. Ph. <br /> I, hereby state that the above information is current,true and correct to <br /> the best JaSan <br /> ledge and agree to utilize my approved commissary in accordance with California Health & <br /> Safety CoJoaquin County Environmental Health Department (EHD) requirements. If the use of the <br /> commissatinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocatioties. <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 U 3-compartment sink [2 Electrical hook-ups <br /> Ey Solid waste disposal [2 Food preparation 12 Toilet and handwashing <br /> B Hot & Cold water for cleaning Q' Store refrigerated food G Potable water <br /> Q Store dry food/supplies 9 Overnight parking U Vehicle wash <br /> I, , 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 Tai s o comLInotify <br /> the conditions of this agreement, or if this agreement is modified or cancelled, the <br /> commis er s the EHD�0LV1/�_ <br /> mediately. <br /> Signature IW� Date 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.sjgov.org/ehd <br />