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SAN JOAQUIN CouNTY Environmental Health Department <br />st2gotigon <br />COMMISSARY AGREEMENT SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <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 Guerrero <br />Owner/Operator Name Kimberly Encarnacion Candia <br />Business Mailing Address 150 Gateway Court <br /> <br />Lic. Plate # 4TWJ868 <br /> <br />City Stockton StateCA Zip 95203 Bus. Ph. 209-430-2883 Alt. Ph. 209-871-4563 <br /> , hereby state that the above information is current, true and correct to <br />the best of my knowledge and agree to utilrze my appr9ved 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 4 /4/24 <br /> <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <br /> <br />FA# 209-464-9707 <br /> <br />Bus. Phone 209-271-1741 <br /> <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate seniices provided: <br />Wastewater disposal <br />Er Solid waste disposal <br />Elf Hot & Cold water for cleaning <br />EI Store dry food/supplies <br />rzt 3-compartment sink <br />12 Food preparation <br />Er Store refrigerated food <br />izi• Overnight parking <br />GI Electrical hook-ups <br />Toilet and handwashing <br />Potable water <br />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 comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary own shall notify t e EHD immediately. <br />Signature Date 4/4/24 <br />Mobile Food Facility * Caterer <br />3. To be completed by the ENV nsdiction 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 />p,q0s31-1-31