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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 />4VF5841 <br />7/28/25Datev <br /> TOR <br /> Date 7/28/25 <br />REHS Signature Date <br />O’ Electrical hook-ups <br />O' Toilet and handwashing <br />ET Potable water <br />O’ Vehicle wash <br />the ENV HEALTH lurisdictjorr 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 />rpent (EHD) requirements. If the use of the <br />ailure to notify this office may result in permit <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />Q Wastewater disposal <br />0 Solid waste disposal <br />E3 Hot & Cold water for cleaning <br />E3 Store dry food/supplies <br />I,_____________ <br />correct to the best <br />operator fails to c <br />commissary owr/e <br />Signature / . <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov org/ehd <br />?R094 <br />s, SANJOAOUIN <br />> 7 ------COUNTY------ <br />Greotness grows hen?. <br /> FA# 209-464-9707 <br />Bus. Phone 209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Riyera <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />Business Name Las Prontas Lie. Plate # <br />Owner/Operator Name Brander Thaly Diaz & Joaquin Delgado San Juan <br />Business Mailing Address 1148 Boardwalk Drive <br />City Stockton StateCA Zip 95206 Bus. Ph. 209-851-5664 Alt. Ph. <br />*>---------- ------------------------------------------------- hereby stat^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 EnvironmentaKHeaJth Departi <br />commissary is discontinued, the permit holder must notif^the^HD^ <br />revocation and penalties. <br />Signature 6 ^{1 <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />Q 3-compartment sink <br />Q Food preparation <br />O' Store refrigerated food <br />S’ Overnight parking <br />, hereby state that the information I have provided is current, true and <br />ofTny knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />;omply with tap conditions ofTms agreement, or if this agreement is modified or cancelled, the <br />Tyshall notify the EHD immeoiafely.