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Environmental Health Department <br />Complete sections 1 and 2. <br />Lie. Plate#4WV9781 <br />Date <br />Date 7/10/25/J <br />REHS Signature Date <br />Commissary Name <br />Address <br />ST 3-compartment sink <br />S' Food preparation <br />S' Store refrigerated food <br />Overnight parking <br />____, hereby s <br />7/10/25 <br />| 2. To be completed by COMMISSARY OWNER/OPERATOR <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />PR 2500521 <br />SAN JOAQUIN <br />------COUNTY------ <br />L reniness ere :r:. <br />If your commissary is located outside of San Joaquin County also complete section 3. <br />1. To be completed by APPLICANT <br />FA# 209-464-9707 <br /> Bus. Phone 209-271-1741 _________ <br />Qwner/Operator Salvador Buenrostro & Carmen Riyera <br />COMMISSARY AGREEMENT dbac^“ca™ng™™wash <br />(40 S CALFORNIA ST Mobile Food Facility ♦ Caterer Stockton, ca 95203 <br />Business Name Taqueria La Bella <br />Owner/Operator Name Amelia Martin Mendoza <br />Business Mailing Address 736 E Church St <br />City, Stockton StateCA Zip 95203 Bus. Ph. 209-649-2248 Alt. Ph. <br />—r—— ------------- ---------------------—■ hereby state that the above information is current, true and correct to <br />e 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. H <br />Signature C ) / (?/ <br />California Catering Truck Wash <br />730 S California St_________ <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I,_____________ <br />correct to the bes' <br />operator fails tZ/c< <br />commissary o’ <br />Signature,h <br />Electrical hook-ups <br />O’ Toilet and handwashing <br />S' Potable water <br />S Vehicle wash <br />—-------------------^-7;e that the information I have provided is current, true and <br />S^my knowled9?/and meets the California Health & Safety Code requirements. If the food facility <br />'comply with thyconditions of this ^reement, or if this agreement is modified or cancelled, the <br />vledge^ <br />1 thy cor <br />le/shall notify/ne EHD immediate^ <br />/t7?/ //7■ ‘ J 1J-. „_____________ <br />3. To bd completecLby the ENV/VlEALTH 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.