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SaNAU I N Environmental Healt a artment <br /> COUNTY D8A CAL IF.VA OR SUENROSTRO <br /> A CATERING <br /> Greatness grc,:.r, h-rc. 730 S CAS ORN�SICK WASi <br /> STOCKTON, CA 95203 <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility * Caterer <br /> Complete sections f and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> 1 . To be com feted b APPLICANT <br /> Business Name Tortas Ahogadas El Tio Lic. Plate# 4BL9515 <br /> Owner/Operator Name Omar A Carrillo <br /> Business Mailing Address 4447 Amador PI <br /> City Stockton StateCA Zip 95207 Bus. Ph. 925-301-6182 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 dis ntinued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation an alties. <br /> Signature Date 4/10/26 <br /> 2. To 6e 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 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> 12 Wastewater disposal 12 3-compartment sink 12 Electrical hook-ups <br /> 13 Solid waste disposal Ck Food preparation 9 Toilet and handwashing <br /> 13 Hot & Cold water for cleaning ®' Store refrigerated food [7 Potable water <br /> 0 Store dry food/supplies 17 Overnight parking 13 Vehicle wash <br /> I. reby state that the information I have provided is current, true and <br /> correct to th best of my knowle , and mee ff <br /> a Califomia Health &Safety Code requirements. If the food facility <br /> operator fa to comply with condition this agreement, or if this agreement is modified or cancelled, the <br /> commissa ow �rs hall notLM <br /> EHD i iately. <br /> Signature Date 4/10/26 <br /> 3. To a com le d b the NV HEALTH 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 /> REHS Signature Date <br /> 1868 E. Hazeiton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />