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S.ANA MU I N Environmental Health Department <br /> .—C-O U N T Y 7D <br /> Greetnesa brows fire, � .. l <br /> SALVA') CUENROSTRO <br /> i)BA CALIFORNIA CATERING TRUCK WASH <br /> COMMISSARY AGREEMENT 7 ��,G� as <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 /> `cmpletec3 by }APPLICANT -- <br /> Business Name Crepetea CC Lic. Plate# 4KJ9730 <br /> Owner/Operator Name Tran Tam Thanh <br /> Business Mailing Address 10136 Blue Anchor Ln <br /> City Stockton StateCA Zip 95219 Bus. Ph. 209-200-6190 Alt. Ph. <br /> I, , 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 3/4/26 <br /> '2. To be completed by COMMISSARY OWNEWPERATOR AN <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 /> 13 Wastewater disposal U 3-compartment sink ifs Electrical hook-ups <br /> 13 Solid waste disposal M Food preparation 12 Toilet and handwashing <br /> ® Hot & Cold water for cleaning G Store refrigerated food U Potable water <br /> Q Store dry food/supplies C$ Overnight parking Er Vehicle wash <br /> I, hereby state that the information I have provided is current, true and <br /> correct to the best my knowledge, and meets the Ca' rnia Health &Safety Code requirements. If the food facility <br /> operator fails to mpiy with the c itions of thi greement, or if this agreement is modified or cancelled, the <br /> commissary ow II notify t D i edi <br /> Signature ' Date 314126 <br /> I. d by th., EN HEALTH "urisdicb n putsjde Hof San Joaq,pin 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. Hazekton Avenue i Stockton, California 95205 1 T 209 468-3420 1 F 209 464-0138 1 www.sjgov.org/ehd <br />