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Authorized Signature: approvals are obtained from all apl4cabIe agencies prior to operation (e.g., fire, zoning, etc.). 7/ Date: • SANiJOAQUIN 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. Indicate the specific sanitizer or sanitizing method that you will use by checking the box below: Contact with a solution of 100 ppm (parts per million) available chlorine for at least 30 seconds. Li Contact with a solution of 200 ppm available quaternary ammonium for at least one (1) minute. Check the option you will use: E Commercial pre-mixed solution or S 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. ,-W 2 All food must be prepared at the approved facility. Home preparation of food is prohibited. Only limited food preparation, as defined in California Retail Food Code (CRFC), is allowed at an off-site food service event. a 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. (g)4 All equipment, utensils and food related items shall not be stored in a private home when not conducting catering activities. 4 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. ("1") 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. a 7 At the end of the operational period, all multi-use utensils will be washed and sanitized at the approved commissary. 1 3) 8 Have access to potable water. 9 All garbage, refuse and liquid waste will be disposed of in an approved manner as approved by the EHD. At the end of the operational period, all multi-use utensils will be washed and sanitized at the 1 10 approved commissary/permitted food facility. At. 1.1. Any food that has become contaminated, suspected of becoming contaminated or presumed unsafe 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 9 7 474 Print Name: Title: 4 of 4