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Environmental Health Department <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />"I <br />Lie. Plate #4WV9836 <br />9/4/25Date <br />To <br />Pate 9/4/25 <br />REHS Signature Date <br />Commissary Name <br />Address <br />S' Electrical hook-ups <br />S Toilet and handwashing <br />Gt Potable water <br />Gt Vehicle wash <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK W/ <br />730SCALFORNIAST <br />STOCKTON, CA 95203COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br /> FA# 209-464-9707 <br /> Bus. Phone 209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera <br />K^^OAOUIN <br />NTY------ <br />revocation and penalties. <br />S ig n atu re <br />O' Food preparation <br />ST Store refrigerated food <br />S' Overnight parking <br />, hereby state that the information I have provided is current, true and <br />z iwledge, and meets the/^lifomia Health & Safety Code requirements. If the food facility <br />/comply with the conditions of tm^agreement, or if this agreement is modified or cancelled, the <br />ner shall notity the EHD immediately. <br />13. 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 />Business Name Panjabi Dhaba <br />Owner/Operator Name Amarjit Singh <br />Business Mailing Address 1816 Decker Ave <br />City Manteca StateCA Zip 95337 Bus. Ph. 209-325-6394 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 />California Catering Truck Wash <br />730 S California St <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />Q Wastewater disposal O' 3-compartment sink <br />0 Solid waste disposal <br />3 Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I, <br />correct to the be^bof my knowlei <br />operator fails to'Comply with <br />commissary owr)er shall noti <br />Signature