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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 #4UT8573 <br />Bus. Ph. 916-356-6668 Alt. Ph. <br />2/20/26DateSignature <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />FA# 209-464-9707 <br />209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera95203 <br />ET Vehicle wash <br />Date 2/20/26 <br />Date PENS Signatu -e <br />operator fails <br />commissary o\Vn. <br />Signature____ <br />GZ Electrical hook-ups <br />GZ Toilet and handwashing <br />ET Potable water <br />The commissc ry 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 commis sary. Please notify EHD if the status of their operating permit changes. <br />COMMISSARY AGREEMENT <br />Mobile Food Facility ♦ Caterer <br />1868 E. Hazelion Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />san joaouin <br />vMWWy J ----COUNTY---- <br />Greatness grows here.SALVADOR BUENROSTRO <br />.a. cr jmnia CATERING TRUCK WASH <br />■'30 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />City Stockton Zi p. <br />Check all appropriate services provided: <br /> Wastewater disposal <br />0 Solid waste disposal <br />0 Hot & Cold water for cleaning <br />0 Store dry lood/supplies <br />I___________________________ <br />GZ 3-compartment sink <br />GZ Food preparation <br />ET Store refrigerated food <br />0 Overnight parking <br />____, 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 />o comply with the conditions of this^greement, or if this agreement is modified or cancelled, the <br />•neg shall notify/he EHD immediacy. <br />I 3. Tobe completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />CommissaryN ame California Catering Truck Wash <br />Address 730 S California St Bus. Phone <br />Stockton <br />Business Name Charly’s Tortas Chilangas LLC <br />Owner/Operator Name Brenda Lopez Serrano <br />Business Mailing Address 350 Horton Ave <br />City Stockton StateCA Zip 95206 <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 />QiYI/VAH rcJdillO|