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Environmental Health Department <br />iZ,pOft^Z <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />MTDMGM6Lie. Plate#Business Name <br />209-601-2166 Alt. Ph. Bus. Ph. <br />9/16/25Date <br />2. To be completed by COMMISSARY OWNER/OPERATQR <br />209-464-9707 <br />Owner/Operator <br />S3 Vehicle wash <br />9/16/25Date <br />Date REHS Signature. <br /> Electrical hook-ups <br /> Toilet and handwashing <br /> Potable water <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />1868 E. Hazelton Avenue I Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />SAN JOAQUIN <br />------COUNTY— <br />Greatness grows here. <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 />| 1. To be completed by APPLICANT______ <br />Danny's Churros and Shaved Ice <br />Ramona Aguilar De Eusebio <br />174 Naomi Cochran Dr <br />Owner/Operator Name <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 />'T' <br />H Wastewater disposal <br /> Solid waste disposal <br /> Hot & Cold water for cleaning <br /> Store dry food/supplies <br />I <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 owner shall notify the EHD immediately. <br />Signature <br />CommissaryNam e California Catering Truck Wash FA# <br />Address 730 South California Street Bus. Phone 209-271-1741 <br />City Stockton zip 95203 Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br /> 3-compartment sink <br /> Food preparation <br /> Store refrigerated food <br /> Overnight parking <br />, hereby state that the information I have provided is current, true and