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SANAMUIN Environmental Health Department <br /> COUNTY <br /> Greatness gnaws here. <br /> 98A CA j pR�CATER NG )STR W COMMISSARY AGREEMENT 73osCALFORNIA <br /> Mobile Food Facility • Caterer S K`roN, CA 95203 <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> Business Name Nancy's Cocktails Lic. Plate# 4DE1478 <br /> Owner/Operator Name JOSE VILLEGAS <br /> Business Mailing Address 1250 E THOMSEN ROAD <br /> City LATHROP State CA Zip 95330 Bus. Ph. 209-981-7579 Alt. Ph. <br /> 1, , 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 Date 12/11/25 <br /> Commissary Name California Catering Truck Wash FA# 209-464-9707 <br /> Address 730 South California Street Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> la Wastewater disposal ® 3-compartment sink E3 Electrical hook-ups <br /> X Solid waste disposal [3 Food preparation C,1 Toilet and handwashing <br /> 13 Hot & Coldwater for cleaning © Store refrigerated food 13 Potable water <br /> 0 Store dry food/supplies C] Overnight parking GVVehicle wash <br /> 1, , 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 �tcomply with t � conditions of, is agreement, or if this agreement is modified or cancelled, the <br /> commissary shall noti the EHD imme ly. <br /> Signature Date 12/11/25 <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 /> REHS 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 /> Pe Qs [' j <br />