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I <br />Environmental Health Department <br />Complete sections 1 and 2. <br />Lie. Plate# 4XD5289 <br />Date <br />REHS Signature Date <br />operator fails' <br />commissary ( <br />Signature <br />O' Electrical hook-ups <br />Q Toilet and handwashing <br />S' Potable water <br />S Vehicle wash <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Wb’ODDOZ <br /> _Date JJ1/18/25 <br />2 To be completed by COMMlSSARY OWNER/OPERATOR <br />FA# 209-464-9707 <br />Bus. Phone 209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera <br />c Greatness grows here. <br />WASH <br />SAN JOAQUIN <br />' -------COUNTY------- <br />s4o comply vyrth the conditb <br />cLner shall Notify the EH <br />__________Date 11/18/25 <br />it>e'DqnipljBted by^ thel ENV^HEALTH junsdjet^ outside^ofSan Joaguin^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 />Et 3-compartment sink <br />Q 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 />COMMISSARYAGREEMENT <br />Mobile Food Facility ♦ Caterer <br />If your commissary is located outside of San Joaquin County also complete section 3. <br /> <br />[1/Toj?e completed by^APPLICANT <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <br />City Stockton Zip 95203 <br />Check all appropriate services provided: <br />Q Wastewater disposal <br />0 Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I, <br />correct to the best of my knowledge, and meZs the California Health & Safety Code requirements. If the food facility <br />of this agreement, or if this agreement is modified or cancelled, the <br />mediately. <br />Business Name La Cabana De Villa <br />Owner/Operator Name Jasmine Mendez <br />Business Mailing Address 350 North Union Road <br />CityJManteca State CA Zip 95337 Bus. Ph. 209-901-8314 Alt. Ph. 209-483-6113 <br />------------------------------------------------ -----------------> 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 penalties. <br />Signature_