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SAN JOAQUIN Environmental Health Department <br /> SALvADOH BUENROSTRO <br /> J3A CALIFORNIA CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT TOCKTON,ORNIA CA9 203 <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 b.e completed by APPLICANT <br /> Business Name Ta uiza with Chava JR Lic_ Plate # 4VN3625 <br /> Owner/Operator Name Salvador Cardenas <br /> Business Mailing Address 5952 Tallahatchey Dr <br /> City Stockton State CA Zip 95215 Bus. Ph. 209-420-6509 Alt. Ph. <br /> 1, , 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 (END) 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 pegalties. <br /> Signature `'7 � Date 7/9126 <br /> 2. To be completed by COMMISSARY OWNER/OPERATOR <br /> Commissary Name California Caterin Truck Wash FA#;F 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 �,e 3-compartment sink 12 Electrical hook-ups <br /> 0 Solid waste disposal 12 Food preparation 9 Toilet and handwashing <br /> I3 Hot & Cold water for cleaning 13 Store refrigerated food 19 Potable water <br /> 9 Store dry food/supplies S Overnight parking U Vehicle wash <br /> l t�by state that the information I have provided is current, true and <br /> correct to the best of fn nowledge, and meets •e California Health-&Safety Code requirements. If the food facility <br /> operator fails to m y with the conditio6s pf this agreement " 1f is agreement is modified or cancelled, the <br /> commissary ow r I e EHD%ifn 'ately. <br /> Signature �/ Al Date 7/9/26 <br /> 3. To b com leted b the ENV HEALTH jurisdiction outside of San Joa uin 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. Hazelton Avenue Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br /> wosq"3 <br />