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Environmental Health Department <br />w!? <br />Lie. Plate#4KJ9730 <br />3/4/26Date <br />Bus. Phone <br />Date 3/4/26 <br />REHS Signature Date <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 />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 />O’ Electrical hook-ups <br />Q Toilet and handwashing <br />S' Potable water <br />S Vehicle wash <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />SANJOAQUIN <br />------COUNTY------ <br />FA# 209-464-9707 <br />209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera <br />ARY OWNER/OPERATOR <br />P*1- • fi j <br />Greatness grows here. <br />Business Name Crepetea CO <br />Owner/Operator Name Tran Tam Thanh <br />Business Mailing Address 10136 Blue Anchor Ln <br />City Stockton StateCA Zip 95219 Bus. Ph. 209-200-6190 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 />O’ 3-compartment sink <br />Q Food preparation <br />GT Store refrigerated food <br />GT Overnight parking <br />, hereby state that the information I have provided is current, true and <br />my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />amply with the conditions of thisz&greement, or if this agreement is modified or cancelled, the <br />r shall notify thdTiHD immedialk^fy. <br />3. To be completed by the EN\/HEALTH jurisdiction outside of San Joaquin Co. <br />08A CAUFOR^A CATFR.mS087*0 <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer CA 95203 <br />obe <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />Q Wastewater disposal <br />0 Solid waste disposal <br />S3 Hot & Cold water for cleaning <br />El Store dry food/supplies <br />I. <br />correct to the best, <br />operator fails to Z <br />commissary ownd <br />Signature / I