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SA N 10 A Q U I N Environmental Health Department <br /> r' n. � 1,.ITY—.. <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 /> 0, Contact with a solution of 100 ppm (parts per million) available chlorine for at least 30 seconds. <br /> ❑ Contact with a solution of 200 ppm available quaternary ammonium for at least one (1) minute. <br /> Check the option you will use: ❑ Commercial pre-mixed solution orX I 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 /> A Catering permit may be used to prepare and serve food at private events and host facilities only. <br /> 1 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 /> Upon request, you must provide your operation schedule to EHD for inspection purposes. NOTE: <br /> 5 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 /> 2 At the end of the operational period, all multi-use utensils will be washed and sanitized at the <br /> approved commissary. <br /> C� 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 /> Co 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 /> Co 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 applicable agencies prior to operation (e.g.,fire,zoning, etc.). <br /> Authorized Signature: Date: 0 2- <br /> Print <br /> Print Name: Title: 0W N2 <br /> 4of4 <br />