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SAN JOAH I N Environmental Health Department <br /> SALVADOR BUENROSTRO <br /> DBA CALIFOHNIA CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT 730S CALIFORNIA <br /> SSTOCKT3 <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 /> LICANT <br /> Business Name Tacos La Yolanda Lic. Plate# 5H78255 <br /> Owner/Operator Name Beniamin Rodriguez Gonzalez <br /> Business Mailing Address 802 W Weber Ave Apt 173 <br /> City STOCKTON State CA Zip 95203 Bus. Ph. 650-771-2750 Alt. Ph. <br /> l 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 discontinue, the permit holder must notify the EHD. Failure to notify this office may result in permit <br /> revocation and per0itiw, <br /> Signature <br /> Date 10/27/25 <br /> ISSARY OWNEMPERATOR <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 /> Q Wastewater disposal 12 3-compartment sink Q Electrical hook-ups <br /> B Solid waste disposal 17 Food preparation U Toilet and handwashing <br /> 0 Hot & Cold water for cleaning U Store refrigerated food U Potable water <br /> E3 Store dry food/supplies EF Overnight parking 16F Vehicle wash <br /> 1, , hereby state that the information I have provided is current, true and <br /> correct to the best my knowledge, and meets the Califomi&Health &Safety Code requirements. If the food facility <br /> operator fails to `mply with the ditions of this ogre ent, or if this agreement is modified or cancelled, the <br /> commissary ow ` r shall notify t END immediate) . <br /> Signature �N !' '` <br /> Date 10/27/25 <br /> e ENV HEALTH -urisdide ., <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 1 T 209 468-3420 1 F 209 46"138 i www.sjgov,org/ehd <br /> wo5013yL4q <br />