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rk LL-1 00393 <br />Environmental Health Department C‘C..!. <br />1. • , SAN JOAQUIN <br />COUNTY <br />`ltiPosz!4‘..` Greatness grows here. <br />COMMISSARY AGREEMENT <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 KN INC DBA ROCK N ROLL <br />Owner/Operator Name KANWALJIT KAUR <br />Business Mailing Address 10820 COMMODORE LANE , <br />City STOCKTON State CA zip 95209 Bus. ph. 209-898-9183 Alt. Ph. <br />KANWALJIT KAUR , 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 penalties. <br />Signature Date 05/01/2025 <br /> <br />To be completed by COMMISSARY OWNER/OPERATOR <br />Commissary Name STOCKTON'S WONDERFUL ICE CREAM <br />Lic. Plate #99915X3 <br />FA# <br />City STOCKTON 95212 Owner/Operator Surender Choumwer Zip <br />Check all appropriate services provided: <br />Wastewater disposal 62( 3-compartment sink 0 Electrical hook-ups <br />Solid waste disposal Er Food preparation I Toilet and handwashing <br />Hot & Cold water for cleaning 17( Store refrigerated food 0 Potable water <br />0 Store dry food/supplies a Overnight parking 0' 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 />commissary ow hall notify the HD immediately. <br />Signature <br /> <br />Date 05/01/2025 <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 />Bus. Phone 209-933-1514 <br />Surender Choumwer <br />Address 1430 E WEBER AVE <br />1868 E. Hazelton Avenue I Stockton, California 95205 I T 209 468-3420 I F 209 464-0138 I www.sjgov.org/ehd