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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 />1. To be completed by APPUCANT <br />4VF5841El Atrakon Lie. Plate #Business Name <br />Karla Martinez <br />8814 Van Allen Rd <br />Bus. Ph. 209-616-8085 Alt. Ph. 209-507-2452 <br />4 7/17/24DateSignature <br />2. To be completed by COMMISSARY QWNER/OPERATOR <br />FA# 209-464-9707California Catering Truck Wash <br />209-271-1741Bus. Phone <br />Owner /Operator Salvador Buenrostro & Carmen Rivera95203Stockton <br />S' Vehicle washStore dry food/supplies <br />7/17/24Date <br />Date PENS Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />O' Electrical hook-ups <br />O' Toilet and handwashing <br />S Potable water <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />lotify the EHD immediately^ <br />i Kauw <br />Owner/Operator Name___ <br />Business Mailing Address <br />City Stockton StateCA Zip 95215 <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, a .0 <br />City Stockton Zip <br />Check all appropriate services provided: <br />y Wastewater disposal S' 3-compartment sink <br />O' Food preparation <br />O' Store refrigerated food <br />ET Overnight parking <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 conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissarV dwner dhall notify the E <br />Signature <br />37To be completed by the ENV HEALTH jurisdiction outside of San Joaquin 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 />Commissary Name <br />Address 730 S California St <br />’SAN JOAQUIN <br />COUNTY-