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Environmental Health Department <br />Complete sections 1 and 2. <br />Business Name Lie. Plate# 1MM6095 <br />Date 03/21/2025 <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Bus. Phone <br />v Vehicle wash <br />3/21/2025Date <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 />Commissary Name <br />Address <br />s/ Electrical hook-ups <br />Toilet and handwashing <br />'Z Potable water <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />SAN JOAOUIN <br />COUNTY <br />California Catering Truck Wash <br />730 S California St <br />Stockton <br />FA# 209-464-9707 <br />209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />vf 3-compartment sink <br />v< Food preparation <br />Y' Store refrigerated food <br />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 />operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary <br />Signature! <br />y owner s^iall notify the EHD immediately. <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 />If your commissary is located outside of San Joaquin County also complete section 3. <br />I 1- To be completed by APPLICANT <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />O Wastewater disposal <br />0 Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />I,______________________________ <br />ELENAS TAQUERIA <br />Owner/Operator Name MARIA ABIGAIL ALCAZAR <br />Business Mailing Address 926 W MATHEWS RD <br />City French camp State CA Zip 95231 Bus. Ph. 209-6709765 Alt. Ph. <br />l>.---------------------------------------------------------- - 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