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SA Ns10AQ U I N Environmental Health Department <br /> �- -----COUNTY „r, <br /> SALVADOR BUENROSTRO <br /> DBA CAt,IFORNI .CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT STOCKTON,ORNIA CA 95203 <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 Delicias Brandy Lic. Plate# 4LU8236 <br /> Owner/Operator Name Andres Valencia <br /> Business Mailing Address 1367 Flint Way <br /> City Fairfield State CA Zip 94533 Bus. Ph. 707-384-8513 Alt. Ph. <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 a d penalties. <br /> Signatur l Date 10/20/25 <br /> L 2. To be copip et-ed by COMMISSARY OWNER/OPERATOR <br /> Commissary Name California Catering Truck Wash FA# 209-464-9707 <br /> Address 730 South California Street Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> ® Wastewater disposal 3-compartment sink Electrical hook-ups <br /> Solid waste disposal Food preparation Toilet and handwashin <br /> P P P 9 <br /> Hot & Cold water for cleaning Store refrigerated food yPotable water <br /> X Stored food/supplies lies Overnight parking gVehicle wash <br /> dry PP 9 P 9 <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 fails to co ply with the c y�ditions of thi greement, or if this agreement is modified or cancelled, the <br /> commissary 7ow6r hall notify th HD immedi ly. <br /> Signature Date 10/20/25 <br /> NV 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 />