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r-- <br /> <br />SAN JOAQUIN <br /> <br />Environmental Health Department <br />—COUNTY-- <br />Greatness grows here. <br />SALVADOR BUENROSTRO <br />MA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT 730 S CALFORN1A ST <br />STOCKTON, 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 DESI TASTE OF INDIA Lic. Plate # 4WG7506 <br />Owner/Operator Name GURDIAL SINGH <br />Business Mailing Address 1243 MONTGOMERY LN <br />City TRACY State CAZip 95377 Bus. Ph. 5598855956 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 (-1. C Date 10/1/2024 <br /> <br />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 />1, <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />Ea Wastewater disposal <br /> rz 3-compartment sink <br /> <br />Mt Electrical hook-ups <br />Er Solid waste disposal <br /> <br />12 Food preparation 12 Toilet and handwashing <br />El Hot & Cold water for cleaning 13 Store refrigerated food <br /> <br />13 Potable water <br />ET Store dry food/supplies Eg Overnight parking 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 comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary t wner sh(all notify the EHD ir1iediately. <br />Signature I ?if <br />Vv{,44 Date 10/1/2024 <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 F 209 464-0138 I www.sjgov.org/ehd <br />po_s o3o0