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Environmental Health Department& <br />Business Name South East Street Grill Lie. Plate #4UW5466 <br />Bus. Ph. 209-616-3213 Alt. Ph. ■ <br />1/21/26Date <br /> <br /> 3 <br />FA# 209-464-9707 <br />Bus. Phone 209-271-1741 <br />Stockton 95203 Owner/Operator Salvador Buenrostro & Carmen Rivera <br />Date 1/21/26 <br />3. To be completed by the <br />REHS Signature Date <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />Pm ooo 3 \ <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br /> p. To be completed by APPLICANT <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 />Commissary Name <br />Address <br />D Electrical hook-ups <br />Q Toilet and handwashing <br />O' Potable water <br />ET Vehicle wash <br />z^lateCA Zip 95206 <br />, hereby state that the above information is current, true and correct to <br />lowledge 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 />Owner/Operator Name Fullstar Darahark Chantha Vong <br />Business Mailing Address 114 W 10th St <br />City Stockton <br />i, <br />thebest-cT rfiy4d <br />Safety Code, a <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 <br />California Catering Truck Wash <br />730 S California St <br />City Stockton Zip <br />Check all appropriate services provided: <br />Q Wastewater disposal <br />0 Solid waste disposal <br /> Hot & Cold water for cleaning <br />E3 Store dry food/supplies <br />I, <br />COMMISSARY AGREEMENT^^^SJroMf**^ <br />Mobile Food Facility ♦ Caterer stockton, ca95203 <br />SAN JOAQUIN <br />------COUNTY------ <br />Greatness grows here. <br />O' 3-compartment sink <br />Q Food preparation <br />Et Store refrigerated food <br />S' Overnight parking <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 oLthis agreement, or if this agreement is modified or cancelled, the <br />commissary owner shall notify the EHD immediately. <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin Co. <br />SALVADOR BUENROSTRO <br />730 S CALFORNIA ST