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1, <br />SAN JOAQUIN Environmental Health Department <br />COUNTY <br />SALVADOR BUENROSTRO <br />DEA CALIFORNIA CATERING TRUCK WASH 730 S CALFORNIA ST COMMISSARY AGREEMENT STOCKT9J, 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 />Business Name Guatemala Baker <br />Owner/Operator Name Agustin Mendoza <br />Business Mailing Address 2342 E Main St <br />City STOCKTON State CA Zip 95205 Bus. Ph. 209-688-8919 Alt. Ph. <br /> , 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 (END) 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 />revocation and penalties. <br />Signature / t-) 7//ten(/'('-'e <br /> Date 5/2/2025 <br />To be completed by COMMISSARY 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 /> <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />:a Wastewater disposal <br />fa Solid waste disposal <br />Hot & Cold water for cleaning <br />PI Store dry food/supplies <br />3-compartment sink <br />rie Food preparation <br />VS.,1 Store refrigerated food <br />ES?: Overnight parking <br />71' Electrical hook-ups <br />la Toilet and handwashing <br />ig Potable water <br />ig Vehicle wash <br /> , hereby state that the information I have provided is current, true and <br />correct to the best my knowledg /and meets the ifornia Health & Safety Code requirements. If the food facility <br />operator fails to mply with t conditions of agreement, or if this agreement is modified or cancelled, the <br />commissary owjf shall notif he EHD imme el <br />Signature pate 5/2/2025 <br />To be completed by the E V 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 />RENS 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 />To be completed by APPLICANT <br />piLo31-1-w Lc. Plate # 4VK2400