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SANAMIN Environmental Health Departr <br />r <br />—COUNTY— gaUE <br />°,r,�wel Greatness grows here 09A CALISALVAmCATEF <br />730 <br />730 S CALFO <br />COMMISSARY AGREEMENT STOCKTON.t <br />Mobile Food Facility • Caterer <br />Complete sections f and 1. !/your commissary is located outside of San Joaquin County also complete sectl <br />Business Name Reyna Del Sur Lic. Plate # 2W22508 <br />Owner/Operator Name Maria Guadalupe Sanchez <br />Business Mailing Address 1620 Sikh Temple St <br />City Stockton State CA Zip95206 Bus. Ph. 209 689 4660 Alt. Ph. <br />1, hereby state that the above information is current, true and cc <br />the best of my knowledge and agree to utilize my approved commissary in accordance with California H <br />Safety Code, and San Joaquin County Environmental Health Department (EHD) requirements. If the us' <br />commissary is discontinued, the permit holder must notify the EHD. Failure to notify this office may result ii <br />revocation and penalties. <br />Commissary Name California Catering Truck Wash FA# 209 464 9707 <br />Address 730 S California St Bus_ Phone 209 464 9707 <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro <br />Check all appropriate services provided: <br />wastewater disposal CPS -compartment sink 0"Clectrical hook-up! <br />$ Solid waste disposal mood preparation B'ioilet and handwa <br />el of & Cold water for cleaning Store refrigerated food CVPotable water <br />Q Store dry food/supplies 13Overnight parking W ehicle wash <br />1, , hereby stale that the information I have provided is Currey <br />correct to the best of my knowledge, and meets the California Health & Safety Code requirements. If the l <br />operator fails to comply with the conditions of this agreement, or if this agreement is modified or car <br />ye commissary is located in County. The above food facilit <br />mmissary requirements in California Health & Safety Code. The above checked services are ava <br />ove commissary. Please notify EHD if the status of their operating permit changes. <br />HS Signature Date <br />4 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.s <br />