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x. <br /> - S A N J O A Q U I N Environmental Health Department <br /> _.....—COUNTY - - <br /> ��c�oa�`.t Gre�tn�cs crr,.i FrrF, SALVADOR13UENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASI <br /> 730 5 CALFORNIA ST <br /> COMMISSARY AGREEMENT srocKTON cAs52o3 <br /> Mobile Food Facility ♦ Caterer i <br /> Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> 1 -To`be com pieted by APPLICANT <br /> Business Name Tacos A La Lena Lic. Plate# 4WB9921 <br /> Owner/Operator Name Abdul Malek Abdul Khaliq <br /> Business Mailing Address 1510 Julian St <br /> City Stockton StateCA Zip 95206 Bus. Ph. 209-601-3561 Alt. Ph. <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 penal 'es. <br /> Signature __ _Date 9/25/25 <br /> 2. To be completed by COMMISSARY OWNEMPERATOR <br /> Commissary Name-. -California Catering Truck Wash FA# 209-464-9707 <br /> Address 730 S California St Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided.- <br /> [3 Wastewater disposal CT 3-compartment sink U Electrical hook-ups <br /> 6 Solid waste disposal [2 Food preparation 12 Toilet and handwashing <br /> ® Hot & Cold water for cleaning 12 Store refrigerated food U Potable water <br /> H Store dry food/supplies ©' Overnight parking U Vehicle wash <br /> I, hereby state tW the information I have provided is current, true and <br /> correct to the best y knowledge, d meets the Califor ealth &Safety Code requirements. If the food facility <br /> operator fails t o ply with the onditions of this a ement, or if this agreement is modified or cancelled, the <br /> commissary o e shall no ify e, immediat <br /> Signature Date 9/25/25 <br /> - - ,- <br /> x <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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.orglehd <br /> YK <br />