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SKJOAQUIN Environmental Health Department <br /> -....., <br /> —COUNTY— <br /> Grev`tness arowa bore. SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALIFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON,CA 95203 <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 . Tobe completed by APPLICANT <br /> Business Name REYNOZOS FOOD TRUCK LLC Lic. Plate# 632931_3 <br /> Owner/Operator Name EDUARDO REYNOZO <br /> Business Mailing Address 1015 W.9TH ST APT1 <br /> City TRACY State CAZIp 95376 Bus. Ph. 9254605441 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 Codeand San Joa uin County Environmental Health Department (EHD) requirements. If the use of the <br /> commissary ;s discontinue the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and penaltie . <br /> Signature Date 5 I !�✓ <br /> be mWe b COMMISSA ' 01N �R/OPV " <br /> ERATOR ` " <br /> Commissary Name California Catering Truck Wash FA# <br /> Address 730 S CALIFORNIA ST Bus. Phone 2092711741 <br /> City STOCKTON Zip 95203 Owner/Operator SALVADOR BUENROSTRO <br /> Check all appropriate services provided: <br /> Wastewater disposal MM3-compartment sink 113Electrical hook-ups <br /> Solid waste disposal CKFood preparation Iv Toilet and handwashing <br /> 12,`Hot & Cold water for cleaning LY�Store refrigerated food U Potable water <br /> Store dry food/supplies Overnight parking Callehicle 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 /> commissary own r shall noti the EHD immediatel . <br /> Signature 2 <br /> Date <br /> 3. To be completed b the ENV HEALTH jurisdictionuoutside of San Joa Lin 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 1 T 209 468-3420 1 F 209 464-0138 1 www.sigov.org/ehd <br />