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PR <br />Environmental Health Department <br />< <br />Complete sections 1 and 2. If your commissary is located outside of San Joaquin County also complete section 3. <br />| 1. To be completed by APPLICANT <br />47850? U. 3Lie. Plate# <br />Alt. Ph. <br />3/25/26Date <br />FA# 209-464-9707 <br />95203 <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 /> Electrical hook-ups <br />EJ Toilet and handwashing <br />Potable water <br />S’ Vehicle wash <br />SANJOAQUIN <br />------COUNTY------- <br />Greotnesi grows here.SALVADOR BUENROSTRO <br />DBA CALIFORNIA CATERING TRUCK WASH <br />COMMISSARY AGREEMENT STOCIOON, CA 95203 <br />Mobile Food Facility ♦ Caterer <br />California Catering Truck Wash <br />_______Bus. Phone 209-271-1741 <br />Owner/Operator Salvador Buenrostro & Carmen Rivera <br />comply with the odn^itions of this^greement, or if this agreement is modified or cancelled, the <br />er &iall notify the EMD immediate <br />£^4 /________________ <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 />Commissary Name <br />Address 730 S California St <br />3-compartment sink <br />Gt Food preparation <br />I2T Store refrigerated food <br />EF 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 coi <br />commissary ownfer <br />Signature______ <br />Owner/OperatorName Kotha Murali Mohan <br />Business Mailing Address 2151 Moffat Blvd <br />City Manteca StateCA Zip 95336 Bus. Ph. 925-964-5871 <br />I, HtVfiAlA KQHAaJ 'IGqTHA 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 <br />2. To be completed by COMMISSARY OWNER/OPERATOR <br />City Stockton Zip <br />Check all appropriate services provided: <br /> Wastewater disposal <br />Ef Solid waste disposal <br />0 Hot & Cold water for cleaning <br />El Store dry food/supplies <br />I_____________________________ <br />Business Name Dosa-N-More