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S A N J O A Q U I N Environmental Health Department --COUNTY All documents listed below must be submitted to the San Joaquin County Environmental Health Department (EHD) prior to beginning catering operations. A field consultation will also be conducted at the proposed commissary to verify that the location is suitable for your catering functions. A signed copy of this document as well as your Environmental Health permit must be maintained with your Catering Operation during all operating hours. Please note that any changes to the menu,equipment,or procedures listed on the approved form will require approval by EHD. Catering Operation Name: Facility ID#: T—A0 0 5_Z l Z`k Business Owner Name: Phone #: 7(L4— Z3 E-mail: r 19 U L'L 5 M . (!'o Website(if applicable) Mailing Address: 13 TO k-U^tn i-s �j er k/ City: S �G «� Zip Code:3 S G( Documents • Include ✓ Check the following items as you include them with this document. ElApplication-Complete and submit the Service Request form. Ensure that all information is legible. Commissary Agreement-The Caterer must prepare and store all food and equipment at a commissary kitchen (permitted food facility).The Caterer and their proposed commissary must complete and sign the commissary agreement.Caterers are subject to limited food preparation only(HSC 113818(a)(4))when conducting direct- sales at a host facility. Specification Sheets- Submit specification or cut sheets for your equipment, including the portable mechanical refrigeration, overhead protection/enclosure, and portable hand-washing sink(s) carts that will I—I be utilized during a Catering event. Provide documentation that shows the certification for sanitation and electrical standards by an American National Standards Institute(ANSI) accredited certification program such as NSF, UL, ETL, etc.for food equipment. EMenu- Include any menus. List all food and beverages items to be sold. (Refer to page 2&5) Food Protection Manager Certification- Provide proof that an owner or employee has a valid Food Manager certificate. Food Handler Card-Provide documentation that all employees have a valid California Food Handler Card. Log-A written log must be maintained for a minimum of 90 days after each operation to include the event 0- organizer name and contact information, location of service, menu of foods and beverages served. When operating at a host facility, the log shall include your menu and location/date/time of operation. Please describe how you will log this information (i.e. What type of database) and provide a sample of that log. 1868 F. Ha7Pltnn AvanuP I Stockton. California 95905 I T 209 468-349n I F 209 4R4-n13R I www.Sicahri_rnm