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- <br />/ ) Oc• <br />(1:a , <br />ASceir Greatness grows here. <br />Environmental Health Department 'SAN JOAQUIN <br />COUNTY <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT 730 S CALFORNIA ST <br />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 />To be completed by APPLICANT <br />Business Name Padilla's Fruit Cocktails Lic. Plate # 1VS6932 <br />Owner/Operator Name Tirso Padilla <br />Business Mailing Address 9388 S Priest Road <br />City French Camp State CA Zip 95231 Bus. Ph. 209-641-1414 Alt. Ph. <br />PadrUct , 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 hol er must notify the EHD. Failure to notify this office may result in permit <br />revocation and penalties. <br />Signature <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name California Catering Truck Wash <br />Address 730 S California St <br /> <br />FA# 209-464-9707 <br />Bus. Phone 209-271-1741 <br />Date 1/7/25 <br /> <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br /> <br />Check all appropriate services provided: <br />Fa Wastewater disposal <br /> <br />Cr 3-compartment sink <br /> 12' Electrical hook-ups <br />Er Solid waste disposal <br /> ra Food preparation El Toilet and handwashing <br />Et Hot & Cold water for cleaning CI Store refrigerated food <br /> er Potable water <br />Ef Store dry food/supplies Er Overnight parking 17 Vehicle wash <br />, hereby state that the information I have provided is current, true and <br />correct to the best of my kçiowledge, and meets the alifornia Health & Safety Code requirements. If the food facility <br />operator fail comply ih the conditions of thi greement, or if this agreement is modified or cancelled, the <br />commissary,/ ner shall o .f the EHD imrrediat <br />/Owl <br />Date 1/7/25 <br />3. 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 />PIZ09.1 OGS; <br />Signature