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COUNTY <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete Section 3. <br /> <br />1.To <br />Business Name Tacos El Guerrero Lie. Plate# 4TWJ868 <br />209-871-4563Alt. Ph. <br /> <br />2. To <br />FA# 209-464-9707 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera95203Stockton <br />ET Vehicle wash <br />4/4/24Date <br />3. To be <br />Date REHS Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br /> <br />O’ Electrical hook-ups <br />EJ Toilet and handwashing <br />Q Potable water <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 />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />GZ 3-compartment sink <br />O' Food preparation <br />ET Store refrigerated food <br />S' Overnight parking <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 owner sh6ll notify the EHD immediately. <br />Signature <br />Commissary Name <br />Address 730 S California St <br />City Stockton Zip <br />Check all appropriate services provided: <br />0 Wastewater disposal <br />0 Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I,___________________________ <br />Owner/Operator Name Kimberly Encarnacion Candia <br />Business Mailing Address 150 Gateway Court ' /_________ <br />City Stockton StateCA Zip 95203 Bus. Ph. 209-430-2883 <br />I,, 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 Date 4/4/24 <br />California Catering Truck Wash <br />Bus. Phone 209-271-1741