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Environmental Health Department <br />4VM1881Lie. Plate# <br />Date <br />my knowledge, and meets the California Health & Safety Code requirements. If the food facility <br />ml\/ \A/i+h ___________. .. . ■'ment, or if this agreement is modified or cancelled, the <br />Date <br />Date <br />■868 E. Hazelton Avenue | Stockton. California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />G? Electrical hook-ups <br />O' Toilet and handwashing <br />O' Potable water <br />O' Vehicle wash <br />6/17/26 <br />| 2. To be completed by COMMISSARY OWNER/OPERATOR <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br /> . 730 $ CALIFORNIA STCOMMISSARY AGREEMENT STOCKTON, GA 96203 <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 /> <br />| 1. To be completed by APPLICANT <br />■ ■ .A-.t- L <br />FA# 209-464-9707 <br />Bus. Phone 209-271-1741 <br />Own er/ Operator Salvador Buenrostro & Carmen Riye ra <br />Business Name Raj Kitchen <br />Owner/Operator Name Simran Walia <br />Business Mailing Address 574 Button Ave apt 271 <br />City Manteca stateCA Zip 95336 Bus. Ph. 559-900-0786 A,t ph <br />K---------------------------------------------------------------- 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 pena|fjjes. ? <br />S ignatu re_______ <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 />Wastewater disposal <br />S’ Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I,_____________ <br />correct to the best <br />operator fails, to / <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here. <br />O 3-compartment sink <br />O’ Food preparation <br />S' Store refrigerated food <br />e? Overnight parking <br />-------, hereby state that the information I have provided is current, true and <br />operator fails, to/comply with the edheiitions of this < <br />commissary owne/shall notify the EHD immediate^ <br />Sig,'ature~pV^{ Datfi 6/17/26_____ <br />ATobecornpLeted by the ENV HEALjriTjurisdiction outside of SanJoaquirf Co. <br />The commissary is located in--------------------------------------------------------County The above food fac meets <br />“^h'ssaty 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