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Environmental Health Department <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />Business Name SMASH N DAAASH BURGERS <br />2093283200 Alt. Ph. <br />Signature. <br />FA# 209-464-9707California Catering Truck Wash <br />209-271-1741Bus. Phone <br />Owner/Operator Salvador Buenrostro & Carmen Rivera95203Stockton <br />O' Vehicle wash <br />Date REHS Signature. <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />commissary/ <br />Signature_ <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 />O' 3-compartment sink <br />EJ Food preparation <br />GT Store refrigerated food <br />ET Overnight parking <br />O' Electrical hook-ups <br />O' Toilet and handwashing <br />O' Potable water <br />SANJOAOUIN <br />------COUNTY------ <br />Greatness grows here. <br />1. To be completed by APPLICANT <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />City Stockton Zip. <br />Check all appropriate services provided: <br />Q Wastewater disposal <br />Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry food/supplies <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 conditionsucf this agreement, or if this agreement is modified or cancelled, the <br />sh^l| notify the EHD immediately. <br />3. To b'e completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />Commissary Name <br />Address 730 S California St <br />Owner/OperatorName SIMRAH SHAFIQ <br />Business Mailing Address2293 EDGEWATER CT <br />City STOCKTOM state CAzio 95204 Bus. Ph.. <br />I,, 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 />Lie. Plate#93291A3 <br />n + 06/22/2026Date___________ <br />n . 06/22/2026Date___________ <br />■r 'T t <br />D8AC=^=0— <br />COMMISSARY AGREEMENT stockton.cAssas <br />Mobile Food Facility ♦ Caterer