Laserfiche WebLink
Environmental Health Department <br />Complete sections 1 and 2. <br />Lie. Plate #4UB4190 <br />Date 03/02/2026 <br />12. To be coi PERATOR <br />Date 03/02/2026 <br />REHS Signature.Date <br />Q Electrical hook-ups <br />Q Toilet and handwashing <br />O' Potable water <br />ET Vehicle wash <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />SANJOAOUIN <br />------COUNTY------ <br />Greotness grows here. <br />1868 E. Hazelton Avenue) Stockton, California 95205 | T 209 468-3420) F 209 464-0138 | www.sjgov.org/ehd <br />If your commissary is located outside of San Joaquin County also complete section 3. <br />11. To be completed by APPLICANT I------------- <br />California Catering Truck Wash FA# 209-464-9707 <br />-----730 S California St Bus. Phone 209-271-1741 <br />Stockton--------------Zip 95203 Owner/Qperator Salvador Buenrostro & Carmen Rivera <br />Commissary Name <br />Address <br />City Stockton________Zip 95203 <br />Check all appropriate services provided: <br />O’ 3-compartment sink <br />O’ Food preparation <br />S' Store refrigerated food <br />S Overnight parking <br />, hereby state that the information I have provided is current, true and <br />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 />* ^^WADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />BusinessName TALIS KITCHEN <br />Owner/Operator Name TALI LATA <br />Business Mailing Address 1813 DECARCI ST <br />City STOCKTON StateCA Zip95206 Bus. Ph. 925/8951715 A|t ph 209/4052243 <br />l’----------------------------------------------------------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 benalti?s. <br />S ig nature ------ <br />Q Wastewater disposal <br />0 Solid waste disposal <br />H Hot & Cold water for cleaning <br />S 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 pwner sh&(l notify thq EHD immediately. <br />S ig n atu re <br />| 3. To be completed by the ENV HEAL