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Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />To becompleted by APPLICANT <br />Don Temoc's Lie. Plate # 3F9F1AA2XRMQ6631QBusiness Name <br />Bus. Ph. 408-442-8474 Alt. Ph. <br />Date 5/15/2025 <br />2. To be completed by COMMISSARY QWNER/OPERATQR <br />FA# 209-464-9707California Catering Truck Wash <br />209-271-1741Bus. Phone <br />Owner/Operator Salvador Buenrostro & Carmen RiveraStockton95203 <br />ET Vehicle wash0Store dry food/supplies <br />lately. <br />5/15/2025Date <br />Date REHS Signature <br />0 <br />0 <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 />CJ Electrical hook-ups <br />O' Toilet and handwashing <br />0 Potable water <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />Owner/Operator Name Cuauhtemoc Avila Aviles <br />3455 Odell Ave <br />ENVIRONMENTAL HEALTH <br />PERMIT/SERVICES <br />COMMISSARY 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 />City Stockton Zip. <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />O' 3-compartment sink <br />O' Food preparation <br />0 Store refrigerated food <br />0 Overnight parking <br />I,, hereby state that the information I have provided is current, true and <br />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary owrjjer shall notify the EHD imi <br />Signature <br />Business Mailing Address <br />City STOCKTON State CA Zip 95206 <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 (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. <br />Signature <br />SAN JOAQUIN^^^^^^^ronmental Health Department <br />county JUN 0 2 2025 <br />Greatness grows <br />Commissary Name <br />Address 730 S California St <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co.