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Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />4VE2221Business Name Mextamales Lie. Plate# <br />Alt. Ph. <br />12/19/25Date <br />FA# 209-464-9707 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera95203Stockton <br />Q Vehicle wash0 <br />12/19/25Date <br />3. To be <br />Date REHS Signature <br />1868 E. Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org/ehd <br />0 <br />0 <br />Commissary Name <br />Address <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 />Comply witl <br />ler shall no# <br />O' Electrical hook-ups <br />Q Toilet and handwashing <br />O' Potable water <br />I,____________._________ <br />correct to the be^yof my knowl <br />operator fails <br />commissary ol <br />Signature/ <br />COMMISSARY AGREEMENT , <br />Mobile Food Facility ♦ Caterer <br />1. To be completed by APPLICANT <br />on outside of San Joaquin Co. <br />City Stockton Zip <br />Check all appropriate services provided: <br />Wastewater disposal <br />Solid waste disposal <br />Hot & Cold water for cleaning <br />Store dry food/supplies <br />California Catering Truck Wash <br />730 S California St Bus. Phone 209-271-1741 <br />Environmental Health-JPepartment <br />STQOKTON, GA 95203 <br />• I <br />Owner/OperatorName Jesus Mateo Reyes <br />Business Mailing Address 639 S Wagner Ave <br />City Stockton StateCA Zip 95215 Bus. Ph. 209-451-7790 <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-j^^^xZ <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />dEryAOAQUIN <br />a iftNisS ----COUNT Y----- <br />Greotness grows here. <br />3-compartment sink <br />Q Food preparation <br />ET Store refrigerated food <br />ET Overnight parking <br />____, hereby state that the information I have provided is current, true and <br />^e, and meets the California Health & Safety Code requirements. If the food facility <br />fie conditions o^nhis agreement, or if this agreement is modified or cancelled, the <br />the EHD imn^oiately. <br />ty thdENV HEALTHjuii