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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 />To be completed by APPLICANT <br />Business Name Leo's Foods Lic. Plate # 4GJ6393 <br /> <br />Owner/Operator Name Raquel Armstrong & Denzel Washington <br />Business Mailing Address 3227 Admiral Dr. <br />City Stockton StateCA Zip 95209 Bus. Ph. 209-346-9825 Alt. Ph. 209-639-8588 <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 />Signature Date 4/8/24 <br />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 />2 Wastewater disposal <br /> <br />3-compartment sink <br /> <br />0" Electrical hook-ups <br />13 Solid waste disposal <br /> <br />0' Food preparation <br /> 12 Toilet and handwashing <br />63' Flat & Cold water for cleaning <br /> ET Store refrigerated food <br /> Er Potable water <br />El Store dry food/supplies <br /> Er Overnight parking <br /> ET 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 co dy with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary owner al tify the <br />Date 4/8/24 <br />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 />9Q0S1A°1030 <br />Signature <br />- / f I immediately. <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203