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Environmental Health Department <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />COMMISSARY AGREEMENT STOCKTON, CA 95203 <br />Mobile Food Facility. Caterer <br />'SAN ..JOAQUIN <br />COUNTY <br />Greatness grows her:: <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 MEXTAMALES Lic. Plate # 4SR9844 <br /> <br />Owner/Operator Name JESUS MATEO REYES <br />Business Mailing Address 639 S WAGNER AVE <br />City Stockton State CA Zip 95215 Bus. Ph. 209-4517790 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 (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 and pen? ti9s. <br />Signature U,—;k1' Date 12/09/24 <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 />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />12 Wastewater disposal <br /> 12 3-compartment sink <br /> 12 Electrical hook-ups <br />Solid waste disposal <br /> Er Food preparation El* Toilet and handwashing <br />121 Hot & Cold water for cleaning ET Store refrigerated food <br /> Ef Potable water <br />Store dry food/supplies Er Overnight parking <br /> El 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 9t,this agreement, or if this agreement is modified or cancelled, the <br />commissary er shall tify the EHD imm€litely. <br />Signature f-vi/0 Date 12/09/24 <br /> <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 209464-0138 I www.sjgov.org/ehd <br />?R250D2s+ <br />1,