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S A N U A Q U I N Environmental Health Department <br /> l COUNTY <br /> f <br /> SALVADOR BUENROSTRO <br /> rr4 r�. DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON,CA 95203 <br /> Mobile Food Facility * Caterer <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 /> Business Name Grind House Lic. Plate# 4FT5610 <br /> Owner/Operator Name Yazan Nassern Suleiman Tardos <br /> Business Mailing Address 2521 Sweet Bay cir <br /> City Tracy State CA Zip 95377 Bus. Ph. 510-999-0464 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 discon nued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and penal <br /> Signature Date 4/15/26 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <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 OwnerlOperator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> Q Wastewater disposal 9 3-compartment sink 1' Electrical hook-ups <br /> U Solid waste disposal U Food preparation 9 Toilet and handwashing <br /> 9 Hot & Cold water for cleaning iX Store refrigerated food R Potable water <br /> 0 Store dry food/supplies Overnight parking 13 Vehicle wash <br /> 1, hereby state th e information I have provided is current,true and <br /> correct to the best my knowledge, and ets the Californi ealth&Safety Code requirements. If the food facility <br /> operator fails to mply with the con do of this afire ent, or if this agreement is modified or cancelled, the <br /> commissary ow r shall notify the E D ' mediately. <br /> Signature Date 4/15/26 <br /> 3. Ta-beacom'pleted byIhe ENV HEALTHiurisdiction outsidd'of:Sah-Joa "uih;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 /> REHS Signature Date <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 i T 209 468-3420 i F 209 464-0138 1 www.sigov.orglehd <br /> -�R 2UO2W � <br />