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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 />SAN JOAQUIN <br />-COUNTY-- <br />GrecariE.,5s grows here. <br />Environmental Health Department <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />730 S CALFORNIA ST <br />STOCKTON, CA 95203 <br />1, <br />To be completed by APPLICANT <br />Business Name APNA PUNJABI DHABA INC Lic. Plate # 4VD4535 <br />Owner/Operator Name BALWINDER SINGH <br />Business Mailing Address 1848 ARCHER AVE <br />City MANTECA StateCA Zip 95337 Bus. Ph. 920)3138891 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 penalties. <br />Date 11/7/24 <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 /> <br />City Stockton Zip 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Check all appropriate services provided: <br />12 Wastewater disposal <br /> cr 3-compartment sink <br /> E' Electrical hook-ups <br />Solid waste disposal <br /> <br />Er Food preparation <br /> Ef Toilet and handwashing <br />E3 Hot & Cold water for cleaning <br /> Er Store refrigerated food <br /> Et Potable water <br />Store dry food/supplies <br /> Er Overnight parking <br /> B. 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 />commissarf /vher shaRnotify the EHD imrriately. <br />UVIVIV t/14/0 <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 />RENS 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 />Signature YN,a/L- <br />Signature ,Date 11/7/2024