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r = SA;RAMIN Environmental Health Department <br /> t <br /> —COUNTY— <br /> ;'N7 <br /> n Grc-u�t'nesa3 grows i1Lere, _ <br /> SALVADOR BUENROSTRO <br /> DBA CALIFORNIA CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT sTOCKrO,CA 5 a3 <br /> Mobile Food Facility♦ Caterer <br /> Complete sections f and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> Business Name LA MESA Lic. Plate# 08727M3 <br /> Owner/Operator Name NELSON A GARCIA MA LAURA GARCIA <br /> Business Mailing Address 3189 SONATA CIR <br /> City STOCKTON State CA Zip 95212 Bus. Ph. 2093617666 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 /> commissaryi ' con inued, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocatio nd penal as. <br /> Signatu 4 Date 10/6/22 <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 Buenrbstro & Carmen Rivera <br /> Check all appropriate services provided: <br /> Ia Wastewater disposal G• 3-compartment sink 17 Electrical hook-ups <br /> 6 Solid waste disposal 17 Food preparation Gr Toilet and handwashing <br /> Ef Hot & Cold water for cleaning U Store refrigerated food U Potable water <br /> E Store dry food/supplies Q Overnight parking 19 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 agreement, or if this agreement is modified or cancelled, the <br /> commissary oAAwner sh linotif, <br /> gqth��e EHD imm tely. <br /> Signature IIIDl l I Y Y U W t VI AAAA\ Date <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.sjgov.org/ehd <br />