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NJ k IN Environmental Health Department <br /> 4 COLD NTY <br /> naa saivq��BAN <br /> { j Greatness groins nerc. CALIPOR I,4CA'T?UENl30�AO <br /> Sr0CK.DN OAgs-r Wp&q <br /> COMMISSARY AGREEMENT : <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 /> Business Name La Garafa Oaxaquena Lic. Plate# <br /> Owner/Operator Name Filogonio Tinoco <br /> Business Mailing Address 160 E Ingram St <br /> Cit Stockton State CA Zip 95294 Bus. Ph. 209-294-8056 Alt. Ph. 209-747-8193 <br /> y , hereby state that the above information is current, true and correct to <br /> I, <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 /> Date 9116/25 <br /> Signature <br /> Commissary Name California Catering Truck Wash FA# <br /> 209-464-9707 <br /> 730 South California Street Bus. Prone 209-271-1741 <br /> Address Salvador Buenrostro & Carmen Rivera <br /> City <br /> Stockton Zip 95203 Owner/Operator <br /> Check all appropriate services provided: <br /> ® Wastewater disposal <br /> Q 3-compartment sink � Electrical hook-ups <br /> 13 <br /> Q Food preparation Toilet and handwashing <br /> p Solid waste disposal Q Potable water <br /> Q Hot & Cold water for cleaning 17 Store refrigerated food 13 Vehicle wash <br /> Q Store dry food/supplies 0 Overnight parking <br /> hereby to that the information l have provided is current, true and <br /> I, ornia Health &Safety Code requirements. If the food facility <br /> correct to th st of my knowle e,and meets the <br /> operator fai a comply with e nditions of thi greement, or if this agreement is modified or cancelled, the <br /> p m is <br /> commissa sl� II no " e N 9/16125 <br /> Date <br /> Signature <br /> County. The above food facility meets the <br /> The commissary is located in <br /> fornia Health & Safety <br /> their o eratirrg perm t changes.services are available at e <br /> commissary requirements in Cali <br /> above commissary. Please notify EHD if the statusP <br /> Date <br /> REHS Signature <br /> 1868 E. Hazelton Avenue l Stockton, California 95206 1 T 209 469-94201 F 209 464-0138 f www.sjgov.orglehd <br /> �� �3 <br />