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Environmental Health Department <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST COMMISSARY AGREEMENT STOCKTON, CA 95203 <br />Mobile Food Facility* Caterer <br />, <br /> <br />o- cst <br /> <br />ti A 0c>' <br />aitiV <br />0,11S0.1r <br />ipoa. <br />'SAN JOAQUIN <br />COUNTY <br />Greatnesc grows her ,. <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 Taco Loco Lic. Plate # 03853B4 <br />Owner/Operator Name Victor Salazar <br />Business Mailing Address 44 S Dawes Ave <br />City Stockton StateCA Zip 95215 Bus. Ph. 209-922-1315 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, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. <br />Signature Date 9/18/24 <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />1, <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <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 />Wastewater disposal <br />Er Solid waste disposal <br />Ea Hot & Cold water for cleaning <br />13 Store dry food/supplies <br />3-compartment sink <br />Food preparation <br />Store refrigerated food <br />13 Overnight parking <br />Electrical hook-ups <br />ri Toilet and handwashing <br />Er Potable water <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 fails to co/pply with the condi •bns of this a. ment, or if this agreement is modified or cancelled, the <br />commissary own e hall notify the EH -nmediately. <br />Date 9/18/24 Signature <br />3 To be completed by the ENV H ALTH jurisdiction utside 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.orgiehd <br />WIC) 0C13-47