Laserfiche WebLink
SAS! JOAQUIN Environmental Health Department <br /> -COUNTY-- <br /> BUIENROSTRO <br /> DBA CAL FORNIAOCATERING TRUCK WASH <br /> COMMISSARY AGREEMENT 730 S CALFORNIA ST <br /> Mobile Food Facility Caterer 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 La Carreta Lic. Plate# 4WK1032 <br /> Owner/Operator Name Jose Pablo Garcia Valdez <br /> Business Mailing Address 8616 Argule Ct <br /> City Stockton State CA Zip 95210 Bus. Ph_ 209-889-4602 Alt. Ph. <br /> 1, _ , 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 en Ities. <br /> Signature - .4 Date 1/8/25 <br /> 2. To be completed b 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 U 3-compartment sink 12 Electrical hook-ups <br /> H Solid waste disposal 12 Food preparation 12 Toilet and handwashing <br /> ® Hot & Cold water for cleaning ET Store refrigerated food R Potable water <br /> ® Store dry food/supplies U Overnight parking 17 Vehicle wash <br /> 1, hereby st& that the information I have provided is current, true and <br /> correct to 9thebest of knowledg , and meets the Calif nia Health &Safety Code requirements. If the food facility <br /> operator co y with th conditions of this a ee ent, or if this agreement is modified or cancelled, the <br /> commissa r s all notify e E D immediately. <br /> Signature ate 1/8/25 <br /> 3. To be c m leted y the ENV HLALTH 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 952051 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br /> r <br />