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SANJ O A Q U I N Environmental Health Department COUNTY 4. Cleaning-Describe the procedures you will use to clean and sanitize food contact surfaces, equipment, and utensils at the commissary. lnndic�at the specific sanitizer or sanitizing method that you will use by checking the box below: L�f Contact with a solution of 100 ppm (parts per million)available chlorine for at least 30 seconds. ❑ Contact with a solution of 200 ppm available quaternary ammonium f t least one (1) minute. Check the option you will use: ❑ Commercial pre-mixed solution or I will prepare my own sanitizer solution Statements Initial next to the below statements indicating that you understand and will abide by them. 1 A Catering permit may be used to prepare and serve food at private events and host facilities only. Operating at a Community Event or Certified Farmers'Market requires a separate health permit. All food must be prepared at the approved facility. Home preparation of food is prohibited. Only 2 limited food preparation, as defined in California Retail Food Code (CRFC), is allowed at an off-site food service event. 3 When operating at an off-site food service event, a sign or business cards must be posted/provided at the event premises stating the Caterer's business name and address. All equipment, utensils and food related items shall not be stored in a private home when not V 4 conducting catering activities. 5 Upon request, you must provide your operation schedule to EHD for inspection purposes. NOTE: Operation at Host Facilities limited to four(4)hours in a twelve(12) hour period. 6 Mechanical refrigeration is required to hold all potentially hazardous food during operation; use of ice, portable cooling blocks,or ice chests/coolers is prohibited. 7 At the end of the operational period, all multi-use utensils will be washed and sanitized at the L.J approved commissary. s� 8 Have access to potable water. All garbage, refuse and liquid waste will be disposed of in an approved manner as approved by the 9 EHD. 10 At the end of the operational period, all multi-use utensils will be washed and sanitized at the approved commissary/permitted food facility. Any food that has become contaminated,suspected of becoming contaminated or presumed unsafe 11 must be discarded. Acknowledgment I understand and agree that if I make changes to my operating procedures, I must notify the EHD within 7 days Failure to notify EHD of any changes may result in suspension or revocation of the Health Permit issued to me to operate as a Catering Operation. Ensure approvals are obtained fr ' all applicable agencies prior to.operation(e.g., fire,zoning, etc.). Authorized Signature: i Date:_'[ !T O Iv 4 Print Name: Title: (.Ji1/�'�