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S A N 1 O A Q U I N Environmental Health Department <br /> --COUNTY------- <br /> Goaatness Brews here. SALVADORBUENROSTRO <br /> '13BA CALIFORNIA CATMRING TRUCK WASH <br /> COMMISSARY AGREEMENT TOCKT N,CA 520 <br /> STOCKTGN,CA 95203 <br /> Mobile Food Facility + Caterer <br /> Complete sections 9 and 2. if your commissary is located outside of,San Joaquin County also complete section 3. <br /> 1. To be com leted by APPLICANT <br /> Business Name Cur On Wheelss Lic. Plate# 372991-1 <br /> Owner/Operator Name Bindiya Rani <br /> Business Mailing Address 2753 Pine Brook Dr_ <br /> City STOCKTON State CA Zip 95212 Bus, Ph. 510-359-9999 Aft. Ph. <br /> 1, , 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 nalties. <br /> s <br /> Signature Date 5/15/2025 <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 /> Q Wastewater disposal ®' 3-compartment sink 12 Electrical hook-ups <br /> 0 Solid waste disposal 1' Food preparation 9 Toilet and handwashing <br /> ® Hot & Cold water for cleaning U Store refrigerated food G Potable water <br /> E3 Store dry food/supplies G Overnight parking III Vehicle wash <br /> 1, hereby hat the information I have provided is current, true and <br /> correct to the best of my knowled ip, and meets the Cai' r Health &Safety Code requirements. If the food facility <br /> operator fails to ompfy with t 'conditions of this r ment, or if this agreement is modified or cancelled, the <br /> commissary r shall noti th tea <br /> Signature Date 5/15/2025 <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 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> FI�Zosq 3to9—+ <br />