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Environmental Health Department <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 />Lie. Plate # 4WG75Q6DESI TASTE OF INDIABusiness Name <br />Bus. Ph. 5598855956 Alt. Ph. <br />Date 10/1/2024Signature <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />FA# 209-464-9707California Catering Truck Wash <br />209-271-1741Bus. Phone <br />Owner/Operator Salvador Buenrostro & Carmen RiveraStockton95203 <br />S' Vehicle wash <br />10/1/2024Date <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 />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 />O' Toilet and handwashing <br />S Potable water <br />lediately. <br />x . SALVADOR BUENROSTRO <br />< DBA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT STOCKTON, CA 95203 <br />Mobile Food Facility ♦ Caterer <br />Commissary Name <br />Address 730 S California St <br />□t 3-compartment sink <br />O' Food preparation <br />O' Store refrigerated food <br />ET 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 faite to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />notify the EHD ii <br />ffWH___ <br />3. To bejcompleted by the ENV HEALTH jurisdiction outside of San_Joaquin_Co. <br />City Stockton Zip. <br />Check all appropriate services provided: <br />Q Wastewater disposal <br />0 Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I,___________________________ <br />Owner/Operator Name GURDIAL SINGH____________ <br />Business Mailing Address 1243 MONTGOMERY LN <br />City TRACY state CAZip 95377 <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 />SAN JOAQUIN <br />-COUNTY- <br />Greatness grows here.