Laserfiche WebLink
'SAN JOAQUIN <br /> <br />Environmental Health Department <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 />1. To be completed by APPLICANT <br />Business Name Padella Italiana Di Mario Lic. Plate # 50637C3 <br />Owner/Operator Name Mario Mora <br />Business Mailing Address 225 W Eaton Ave 22 <br />City Tracy StateCA Zip 95376 Bus. Ph. 925-577-1130 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 disgbntiued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and pfialt,s. <br />Date 8/6/24 Signature <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 <br /> Bus. Phone 209-271-1741 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />cit Wastewater disposal <br /> Et 3-compartment sink <br /> CZ Electrical hook-ups <br />B' Solid waste disposal <br /> GI' Food preparation 12 Toilet and handwashing <br />El Hot & Cold water for cleaning Eir Store refrigerated food <br /> ET Potable water <br />Store dry food/supplies Er Overnight parking Er 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 thi greement, or if this agreement is modified or cancelled, the <br />commissary own shall notify e EHD immediat <br />Signature Date 8/6/24 <br /> <br />3. To be completed by the ENV EALTH 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 END 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 />FR 05 00312-