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/ �• ' a SANA UIN :f7viron.mental Health Department <br /> —CCUti <br /> COMMISSARY AGREEMENT <br /> Mobile Food Facility + Caterer <br /> Complale aacdorta f and Z if your commissary is located outside of Sen Joltqusn County also complete sec dr 3. <br /> Business Name Delicias La Piedad t z Platen 8A46711 <br /> Owner/Operator Name Jose L. Zarate ` <br /> Business Ma i ng Address 1441 S. American St <br /> City Stockton State Ca Zip_15206 Bus, Ph. (209) 641-4775 Alt. Ph. _ <br /> Jose L. Zqrate . hereby state that the above inforrration is current.true anc correct to <br /> the best of my Knowledge and agree to utilize my approved commissary in accordance with California neaith & <br /> Safety Code, enc San Joaquin County Environmentai Health Department (END) 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 pemat <br /> revocation and penalties. <br /> Signaturec�(7e1U & g(t yr �P. /ill 7ata 10/6/2021 <br /> Commissary NameCalifornia Catering Truck Wash <br /> Addres6 730 S. California St Bus phone (209) 464-9707 <br /> C.ty Stockton ._„Zip 95203 _ owner,Operaw Salvador Buenrostro <br /> ChecK all appropriate services provided; <br /> [3 Nastewater disposal Ct 3-compartment Sink 13 Eiectrical hook-ups <br /> C] Solid waste disposal 17 Food reparattor U Toilet ano nanewasr:ng <br /> 17 Hot&Cold water for cleaning 13 Store refrigerated food C3 Potable water <br /> C} Store dry food supplies O Ovem gnt parking CJ Vehicie wash <br /> nereay state that the information,, t nave provided is currern. *sue 8nc <br /> cones to the best of my knowleoge, and meets the Caiifornis Huth&Safety C-4a requirements If the food facilir; <br /> operator faits t mply with the vonditions of this agreement. or If this agreement is modified or canceilea, '.he <br /> rommia9ary ( r II n�11�1,mmodmle�,Iy <br /> e per® 10/6/2021 <br /> 7"- commissary is wcated in County, "ne above food facti;fy meets thr <br /> er,.r.tssary requirements in Califon,;§ Health & Safety Code The above checked services are avaiiabit at the <br /> aoove wrnmissery Please notify Eno f the status of their operating permit changes. <br /> RENS Signature._,_- "'ate <br /> '868 E. Hazelton Avenue � Stockton, California 95235 i T 209 468-3433 c .;09 494-0138 1 www.sigok.orgiehc <br />