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SAN JOAQUIN <br /> <br />Environmental Health Department <br />COUNTY - <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <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 <br />Owner/Operator Name Gurdial Singh <br />Business Mailing Address 1243 Montgomery Lane <br />City Tracy StateCA Zip 95377 Bus. Ph. 559-885-5956 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 (END) 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 A <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 />12 Wastewater disposal <br /> <br />Ur 3-compartment sink <br /> <br />12 Electrical hook-ups <br />Solid waste disposal <br /> <br />Cr Food preparation 12 Toilet and handwashing <br />El Hot & Cold water for cleaning ET Store refrigerated food <br /> Cr Potable water <br />Store dry food/supplies • Overnight parking Vehicle wash <br /> , hereby state that the information I have provided is current, true and <br />correct to the be ,4t of my knowl ge, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails comply wit t conditions of t s agreement, or if this agreement is modified or cancelled, the <br />commissary c4ier shall n e EHD immedi <br />Lic. Plate # 4WG7506 <br />1, <br />Date 04/1/25 <br />pate 04/1/25 Signature <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 />RENS 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 />20oDD