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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 APPLICANT <br />Lie. Plate#6E96015 <br />Alt. Ph. <br />Date 7/18/25 <br />2. To be completed by COMMISSARY QWNER/OPERATQR <br />California Catering Truck Wash FA# 209-464-9707 <br />209-271-1741Bus. Phone <br />Owner/Operator Salvador Buenrostro & Carmen RiveraStockton95203 <br />ET Vehicle wash <br />Date 7/18/25 <br />Date REHS Signature <br />commissary ow, <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 />Q Food preparation <br />O' Store refrigerated food <br />O' Overnight parking <br />O' Electrical hook-ups <br />O' Toilet and handwashing <br />O' Potable water <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />LTH jurisdiction outside of San Joaquin Co. | <br />SAN JOAQUIN <br />COUNTY- <br />Greotness grows here. <br />Business Name Tacos Guadalajara <br />Owner/Operator Name Ernesto Vizcaino Hernandez <br />Business Mailing Address 1457 S San JQaquin St <br />City Stockton StateCA Zip 95206 Bus. Ph. 209-405-4097 <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 />Signature <br />Commissary Name <br />Address 730 S California St <br />City Stockton Zip <br />Check all appropriate services provided: <br />Q Wastewater disposal O' 3-compartment sink <br />EF 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/Jornply with thS'.conditions of this/^gyfeement, or if this agreement is modified or cancelled, the <br />w^ar shall notif^the EHD immediately <br />3. To be completed by the ENV H <br />DBA CALIFORMA CATCRINGTOCK WASH <br />COMMISSARY AGREEMENT stoc8®^ <br />Mobile Food Facility ♦ Caterer