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act" <br />SAN JOAQUIN <br />COU N TY <br />Greotness grows here. <br />Environmental Health Department <br />COMMISSARY AGREEMENT <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 />Owner/Operator Name HENRE' LOSONGCO <br />Business Mailing Address 1003 Lake Park Ave #130 <br />City Galt State CA zip 95632 Bus. ph. (209) 329-4294 Alt. Ph. (209) 329-7717 <br />Henre' Losongco , 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 disco ed, the ,permit holder must notify the EHD. Failure to notify this office may result in permit <br />revocation and pe I s. <br />Signature Date <br /> <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name UNION CATERING TRUCK CENTER <br />Address 1717 S UNION ST Bus. Phone (209) 298-5416 <br />City STOCKTON 95206 Owner/Operator ART TIRADO Zip <br />Check all appropriate services provided: <br />Lic. Plate #5Z51032 <br />FA# <br />Business Name TAI'MA'ANAO MANUNU <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />3-compartment sink <br />Food preparation <br />E3 Store refrigerated food <br />Overnight parking <br />0 Electrical hook-ups <br />El Toilet and handwashing <br />0 Potable water <br />El Vehicle wash <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 />operator fails to comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissary owner shall notify the EHD immediately. <br />Signature Date <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 95205 T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />Art Tirado