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SANJ O A Q U I N Environmental Health Department <br /> — <br /> -- COUNTY- - <br /> 4. Cleaning-Describe the procedures you will use to clean and sanitize food contact surfaces,equipment, <br /> and utensils at the commissary. <br /> indicate the specific sanitizer or sanitizing method that you will use by checking the box below: <br /> 1, ntact with a solution of 100 ppm (parts per million)available chlorine for at least 30 seconds.d sk �►a�1.r�,� <br /> Lel Contact with a solution of 2000 available quaternary ammonium for at least one(1)minute. all�ar lurJ�.,11 <br /> Check the option you will use: VJ Commercial pre-mixed solution or 111 will prepare my own sanitizer solution <br /> Statements <br /> Initial next to the below statements indicating that you understand and will abide by them. <br /> 1 A Catering permit may be used to prepare and serve food at private events and host facilities only. <br /> Operating at a Community Event or Certified Farmers'Market requires a separate health permit. <br /> All food must be prepared at the approved facility. Home preparation of food is prohibited. Only <br /> 2 limited food preparation, as defined in California Retail Food Code (CRFC), is allowed at an off-site <br /> food service event. <br /> 3 When operating at an off-site food service event,a sign or business cards must be posted/provided <br /> at the event premises stating the Caterer's business name and address. <br /> (� 4 All equipment, utensils and food related items shall not be stored in a private home when not <br /> conducting catering activities. <br /> 5 Upon request, you must provide your operation schedule to EHD for inspection purposes. NOTE: <br /> Operation at Host Facilities limited to four(4)hours in a twelve(12)hour period. <br /> 6 Mechanical refrigeration is required to hold all potentially hazardous food during operation; use of <br /> ice,portable cooling blocks,or ice chests/coolers is prohibited. <br /> 7 At the end of the operational period, all multi-use utensils will be washed and sanitized at the <br /> approved commissary. <br /> 8 Have access to potable water. <br /> 9 All garbage, refuse and liquid waste will be disposed of in an approved manner as approved by the <br /> EHD. <br /> 10 At the end of the operational period, all multi-use utensils will be washed and sanitized at the <br /> approved commissary/permitted food facility. <br /> r 11 Any food that has become contaminated,suspected of becoming contaminated or presumed unsafe <br /> must be discarded. <br /> Acknowledgment <br /> 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 <br /> of any changes may result in suspension or revocation of the Health Permit issued to me to operate as a Catering Operation.Ensure <br /> approvals are obtained from all applica prig peration(e.g.,fire,zoning,etc.). <br /> Authorized Signature: Date: <br /> II <br /> Print Name: S� FI LS tin Title: a) L-r- <br /> 4of4 <br /> I <br />