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SA N j4J O AQ U I N Environmental Health Department <br /> COUNTY <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON.CA 95203 <br /> Mobile Food Facility • Caterer <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 EIA avero Lic. Plate# 4TU3146 <br /> Owner/Operator Name Ruben Garcia <br /> Business Mailing Address 1972 Auto Ave <br /> City Stockton StateCA Zip 95205 Bus. Ph. 209-598-4961 Alt. Ph. <br /> I, , 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 (END) 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.nd <br /> Signature " #'Vlli iAO& Aoalix Date 7114125 <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 Q' 3-compartment sink Q' Electrical hook-ups <br /> Q Solid waste disposal Q Food preparation 12 Toilet and handwashing <br /> H Hot & Cold water for cleaning (9 Store refrigerated food Ua' Potable water <br /> H Store dry food/supplies ©' Overnight parking Q' Vehicle wash <br /> I, hereby state that the information I have provided is current, true and <br /> correct to the besfbf my knowledA, and meets the C lifornia Health &Safety Code requirements. If the food facility <br /> operator fails t omply with a conditions of th g ement, or if this agreement is modified or cancelled, the <br /> commissary r shall nthe EHD imme <br /> otidi y. <br /> Signature Date 7114125 <br /> 3. To be com leted 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 /> BENS 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 /> rkos' I �ZZ <br />