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Environmental Health Department <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />_JLt To be completed by APPLICANT <br />47850) U-3Lie. Plate#Business Name Dosa-N-More <br />Alt. Ph. <br />3/25/26Date <br />ZZJ <br />FA# 209-464-9707 <br />209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera95203Stockton <br />Date 3/25/26 <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 />operator fails to coi <br />commissary owtfer <br />Signature______ <br />O’ Electrical hook-ups <br />Q Toilet and handwashing <br />12 Potable water <br />O’ Vehicle wash <br />• - V <br />California Catering Truck Wash <br />Bus. Phone <br />City Stockton Zi p. <br />Check all appropriate services provided: <br />Q Wastewater disposal <br />O' Solid waste disposal <br />Q Hot & Cold water for cleaning <br />0 Store dry food/supplies <br />I <br />ISt 3-compartment sink <br />12 Food preparation <br />12 Store refrigerated food <br />12T 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 />comply with the odnclitions of this^greement, or if this agreement is modified or cancelled, the <br />fer s&all notify the EHD immediawj/ <br />3. To be completed by the ENV HEALTH jurisdiction outside of San Joaquin 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 />SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT STOCKTON, CA 95203 <br />Mobile Food Facility ♦ Caterer <br />^iSANJOAOUIN <br />-------COUNTY------- <br />Greotnesi grows here. <br />Commissary Name <br />Address 730 S California St <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />Owner/Operator Name Kotha Murali Mohan <br />Business Mailing Address 2151 Moffat Blvd <br />City Manteca StateCA Zip 95336 Bus. Ph. 925-964-5871 <br />I, NiQHAN ICqTHA 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 />S ig natu re