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" SAN:J OA Q U I N Environmental Health Department <br /> f - COUNTY— <br /> S STRO <br /> Grerarnesa gral 'Acre. SALVADOR TERINGBUIENRRUC <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> 730 S CALIFORNIA ST <br /> COMMISSARY AGREEMENT STOCKTON,CA95203 <br /> Mobile Food Facility • Caterer _y <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 /> Business Name Tacos La Bahia Lic. Plate# 4TL9221 <br /> Owner/Operator Name Israel Ruelas <br /> Business Mailing Address 1867 Florida St <br /> City Hayward State CA Zip 94545 Bus. Ph. 510 756 7022 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 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 /> revocationandp/g7n�a ties. <br /> Signatur_ \r 11 � Date 8/15/22 <br /> 2. To be completed by COdi MMSARY OWNEMPERATOR <br /> Commissary Name California Catering Truck Wash FA# 209-464-9707 <br /> Address 730 S California St Bus. Phone 209-271-1741 <br /> City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> Check all appropriate services provided: <br /> 12 Wastewater disposal 17 3-compartment sink 17 Electrical hook-ups <br /> E3 Solid waste disposal G7 Food preparation 17 Toilet and handwashing <br /> H Hot& Cold water for cleaning 9 Store refrigerated food M Potable water <br /> H Store dry food/supplies EF Overnight parking U Vehicle 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 greement, or if this agreement is modified or cancelled, the <br /> commissary o ne,r shall tify the EHD immediat y. <br /> Signature Date 8/15122 <br /> 3. Tobe Completed by the rENV HEALTH jurisdiction outside df 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 1 T 209 468-34201 F 209 464-0138 1 www.sjgov.org/ehd <br />