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SANJOAQUIN <br />COUNTY <br />Greatness grows her <br />Environmental Health Department <br />SALVADOR BUENROSTRO <br />_DBA CALIFORNIA CATERING TRUCK WASH COMMISSARY AGREEMENT 730 S CALFORNIA ST <br />STOCKTON, CA 95203 <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 Hot Dogs La Tapatia <br />Owner/Operator Name Adriana lniguez Ayala <br />Business Mailing Address 1751 W Alpine Ave <br /> <br />Request #: <br />Lic. Plate # AP2401056 <br /> <br />City Stockton StateCA Zip 95204 Bus. Ph. 209-888-9167 Alt. Ph. <br />, hereby state that the above information is current, true and correct to <br />Mobile Food Facility. Caterer <br />the best of my knowledge and <br />Safety Code, and San Jo <br />commissary is discontinu <br />revocation and penalties. <br />Signature <br />e to utilize my approved commissary in accordance with California Health & <br />unty Environmental Health Department (EHD) requirements. If the use of the <br />permit holder must notify the EHD. Failure to notify this office may result in permit <br />Date 9/19/2024 <br />To be completed by OMMISSARY OWNER/OPERATOR <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 />Wastewater disposal <br /> C' 3-compartment sink <br /> Electrical hook-ups <br />Ei Solid waste disposal <br /> 12 Food preparation 12 Toilet and handwashing <br />El Hot & Cold water for cleaning GT Store refrigerated food <br /> <br />Er Potable water <br />El Store dry food/supplies 13* Overnight parking Er Vehicle wash <br /> 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 com ly with the conditionf this agreement, or if this agreement is modified or cancelled, the <br />commissar I notify the EHD im ecnately. <br />if U./71 <br />To be completed by the ENV HEALTH jurisdiction outside of 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 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd <br />?g DOra-5 <br />Signature Date 9/19/2024