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Greatness grows he, <br />COMMISSARY AGREEMENT <br />Mobile Food Facility • Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOC1CTON, CA 95203 <br />SANJOAQUIN <br /> <br />Environmental Health Department <br />COU NTY <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 California Ice King <br />Owner/Operator Name Martin King <br />Business Mailing Address 29 W Lancaster Dr <br />City Stockton StateCA Zip 95207 Bus. Ph. 209--888-9490 Alt. Ph. <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, ,$,e p m'iholder must notify the EHD. Failure to notify this office may result in permit <br />revocation and.pflties. <br />Lic. Plate # 4VJ8974 <br />Date 8/22/24 Signature 77, <br />2. 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 />Bus. Phone 209-271-1741 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />Et Wastewater disposal <br /> <br />12 3-compartment sink <br /> <br />Et Electrical hook-ups <br />Ef Solid waste disposal <br /> Et Food preparation <br /> Et Toilet and handwashing <br />EI Hot & Cold water for cleaning ET Store refrigerated food <br /> Er Potable water <br />El Store dry food/supplies Cr Overnight parking <br /> 13 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 fail5 tp comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary a er s II notify the EHD imyiediately. <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 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />00011 <br />Signature 0'4\ Date 8/22/24