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SAN JOAQUIN <br />—COUNTY-- <br />Greatness grows here. <br />Environmental Health Department <br />COMMISSARY AGREEMENT <br />Mobile Food Facility. Caterer <br />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <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 Crepetea Co. <br />Owner/Operator Name Tram Tam Thanh <br />Business Mailing Address 10136 Blue Anchor Ln <br /> <br />Lic. Plate # 04794A3 <br /> <br />City Stockton <br /> <br />State CA Zip 95219 Bus. Ph. 209-200-6190 Alt. Ph. <br /> <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 />Signature Date 12/12/24 <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 />Er Wastewater disposal Er 3-compartment sink <br />Ef Solid waste disposal 0 Food preparation <br />E3 Hot & Cold water for cleaning Er Store refrigerated food <br />13 Store dry food/supplies Er Overnight parking <br />correct to the best my knowle e, and meets the California Health & Safety Code requirements. If the food facility <br />operator fails to q4mply with te c nditions of this a. - ent, or if this agreement is modified or cancelled, the <br />commissary ovqnrjshlI noti HD immediately. <br />12 Electrical hook-ups <br />Et Toilet and handwashing <br />Et Potable water <br />13 Vehicle wash <br />hereby state that the information I have provided is current, true and <br />Date 12/12/24 Signature <br />3. To be completed by the ENV ALTH jurisdiction outside of San Joaquin Co. <br /> <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 209 464-0138 I www.sjgov.org/ehd <br />2c 0029v