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SAN JOAQU I N Environmental Health Department <br /> COUNTY <br /> SAL.VADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT STOCKTON,CA 95203 F.; <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 /> 1 . To be completed by APPLICANT <br /> Business Name Don Jorges Lie. Plate# 4WN6073 <br /> Owner/Operator Name Jorge Cesneros-Figueroa <br /> Business Mailing Address 2185 Stormy Creek Ct. <br /> City Stockton State CA Zip 95206 Bus. Ph. 650-207-6390 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 and penalties. <br /> Signature Date 2/21/25 <br /> 2. 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 /> U Wastewater disposal [2 3-compartment sink 17 Electrical hook-ups <br /> B Solid waste disposal [2 Food preparation G Toilet and handwashing <br /> Q Hot & Cold water for cleaning 9 Store refrigerated food G Potable water <br /> 0 Store dry food/supplies 9 Overnight parking 19 Vehicle wash <br /> I, hereby state he information I have provided is current, true and <br /> correct to the bes f my knowledge and meets the Califor ealth &Safety Code requirements. If the food facility <br /> operator fails tq, omply with the ditions of this a ent, or if this agreement is modified or cancelled, the <br /> commissary o r shall notify HD immediately <br /> SignatureA Date 2/2'1/25 <br /> 3. To b completed by the ENV FTEALTH 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 /> p(22 S12 S--H <br />