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SAN JOAQUIN <br />Heaitri cOUN Sl y. <br />SALVADOR BUENROSTRO <br />DBA CAUFORNIA CATERING TRUCK WAS, <br />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 />To be completed by APPLICANT <br />Business Name Tortas Ahogadas La Patrona <br />Owner/Operator Name Janette Berenice Jimenez Garcia <br />Lic. Plate # 7V68146 <br /> <br />Business Mailing Address 219 Duncan Ave <br />City Stockton StateCA Zip 95207 Bus. Ph. 209-518-9500 Alt. Ph. 209-373-7081 <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 (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 />revocation Td penali ies. <br />Signature, <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 />Wastewater disposal <br />2 3-compartment sink <br />'iLs Electrical hook-ups <br />R. Solid waste disposal <br />Qfr Food preparation Toilet and handwashing <br />Hot & Cold water for cleaning Store refrigerated food <br />Potable water <br />Wi Store dry food/supplies 7 Overnight parking r,Y, 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 comply with the conditions of this agreement, or if this agreement is modified or cancelled, the <br />commissa ner s VI notify the EHD immedi ly. <br />Signature n(0 A - M nAgio A k i 4 A Date 7/1/24 <br />\ ,, !wiv <br />TO be''edfilifete Y- he'':-ENV44EALIFIV-Mfotitiirollfgrde'..-br8ViJoaquin 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 T 209 468-3420 F 209 464-0138 www.sjgov,org/ehd <br />Pg2s0CeScl <br />COMMISSARY AGREEMENT <br />Mobile Food Facility Caterer <br />41,1,e-fric 2- <br /> <br />2L1.\ C Date 7/1/24 <br />