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Environmental Health Department <br />Lie. Plate#4WH3700 <br />Bus. Ph. 209-302-4314 <br />Z 5/30/25Date <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Bus. Phone <br />igreement, or if this agreement is modified or cancelled, the <br />Date 5/30/25 <br />REHS Signature Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />operator fails to c< <br />commissary o' <br />Signature <br />Commissary Name <br />Address <br />O' Electrical hook-ups <br />S' Toilet and handwashing <br />S' Potable water <br />S' Vehicle wash <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />SAN JOAOUIN <br />------COU NTY <br />Greotness arews here. <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 />FA# 209-464-9707 <br />209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WAS <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />O' 3-compartment sink <br />O' 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 />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />x. , tQ comply wjth th~ CQncjjtions of thk <br />ivjfner/shall notify we EHD immediap^ <br />3. 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 Tropical Crunch <br />Owner/Operator Name Jose Antonio Hernandez <br />Business Mailing Address 2532 E Poplar St <br />City Stockton StateCA Zip 95205 Bus. Ph. 2U9-3U2-4314 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 />revocation and penalties. <br /> Signature <br />California Catering Truck Wash <br />730 S California St <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />O Wastewater disposal <br />S' Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I,_________________________