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SAN�JQAQUIN Environmental Health Department <br /> COUNTY <br /> -. <br /> N w Greatness brows here. D$� :;a��k kR R BUENROSTRO 4 <br /> ..ATERING TRUCK WASH <br /> 130 c CALFORNIA ST <br /> COMMISSARY AGREEMB T STOCKTON, CA95203 <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 /> 1. To be completed-by APPLICANT <br /> Business Name TACOS PIKORIN Lic. Plate# 4VM5805 <br /> Owner/Operator Name FRANCISCO J HINOJOSA MIREYA <br /> Business Mailing Address 2513 BURLINGTON PL <br /> City STOCKTON StateCA Zip 95209 Bus. Ph. 209/4256332 Alt. 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 an penalties. <br /> Signature Date 3/26/26 <br /> 2. To be completed by COMMISSARY OWNEMPERATOR <br /> Commissary Name California Catering Truck Wash FA# 209-464-9707 <br /> Address 730 S California St Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> 12 Wastewater disposal ©' 3-compartment sink Q' Electrical hook-ups <br /> Q Solid waste disposal 62 Food preparation 12 Toilet and handwashing <br /> E3 Hot & Cold water for cleaning G Store refrigerated food U Potable water <br /> E7 Store dry food/supplies 17 Overnight parking U Vehicle wash <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 /> commissaryfter shall notify the EHD imm diately.. <br /> Signature / Date 3/26/26 <br /> 3. To 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 /> REHS Signature Date <br /> 1868 E. Hazelton Avenue I Stockton, California 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> PC,2t11 <br />