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Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />Lie. Plate# <br />Bus. Ph.669-268-5162 A|t Ph 414-841-5034 <br />Date <br />:ratoro•e <br />FA# 209-464-9707California Catering Truck Wash <br />209-271-1741Bus. Phone <br />Owner/Operator Salvador Buenrostro & Carmen Rivera95203Stockton <br />0 <br />Date REHS Signature. <br />Q <br />0 <br />0 <br />O' Electrical hook-ups <br />Q Toilet and handwashing <br />0 Potable water <br />O' Vehicle wash <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420] F 209 464-0138 | www.sjgov.org/ehd <br />R?2ApW0-Z <br />SANJOAQUIN <br />-----*-C O U N T Y— <br />Greotness grows here. <br />Q 3-compartment sink <br />O' Food preparation <br />S' Store refrigerated food <br />0 Overnight parking <br />I,. 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 fails to comply with the conditb <br />commissary ownei <br />Signature!^ <br />City Stockton Zip. <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />Business Name MAD DOG S STREET DOGS <br />Owner/Operator NameALEKS MALINOVIC <br />Business Mailing Address 6618 LADY BIRD WAY <br />cjty STOCKTON StateCA Zip95209 <br />I ALEKS MALINOVIC, 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 pen^ltie?< . <br />Signature ---------------------- Date 2^1. <br />Environmental Health Department <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />Commissary Name <br />Address 730 S California St <br />is of this agreement, or if this agreement is modified or cancelled, the <br />ner sh^ll notify the EHDYn/mediately. | I ,I pu M Date 3 UU___ <br />3. To be completed by the ENV 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 /> <br />o be