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SAN JOAQUIN <br />COUNTY— <br />Environmental Health Department <br />All documents listed below must be submitted to the San Joaquin County Environmental Health Department <br />(EHD) prior to beginning catering operations. A field consultation will also be conducted at the proposed <br />commissary to verify that the location is suitable for your catering functions. A signed copy of this document as <br />well as your Environmental Health permit must be maintained with your Catering Operation during all operating <br />hours. <br />Please note that any changes to the menu, equipment, or procedures listed on the approved form will require <br />approval by EHD. pp <br />Catering Operation Name: C.� Facility ID#: y1 <br />Business Owner Name: ��/'� Phone #: �y <br />E-mail: ^ r��� 7i)LU , Website(ifapplicable) 1G7OG7.U),^��(hhS YVQItYS�,(' 7� <br />Mailing Address: At"I UW k SL City: sow ✓[�ili��'y Zip Code: 4`!3 G;i <br />Documents•Include <br />✓ Check the following items as you include them with this document. <br />❑Application- <br />Complete and submit the Service Request form. Ensure that all information is legible. <br />❑ <br />Commissary Agreement -The Caterer must prepare and store all food and equipment at a commissary kitchen <br />(permitted food facility). The Caterer and their proposed commissary must complete and sign the commissary <br />agreement. Caterers are subject to limited food preparation only (HSC 113818(a) (4)) when conducting direct - <br />sales at a host facility. <br />Specification Sheets- Submit specification or cut sheets for your equipment, including the portable <br />refrigeration, overhead protection/enclosure, and portable hand -washing sink(s) carts that will <br />❑mechanical <br />be utilized during a Catering event. Provide documentation that shows the certification for sanitation and <br />electrical standards by an American National Standards Institute (ANSI) accredited certification program such <br />as NSF, UL, ETL, etc. for food equipment. <br />Menu- Include any menus. List all food and beverages items to be sold. (Refer to page 2 & 5) <br />PiElDertificate. <br />od Protection Manager Certification- Provide proof that an owner or employee has a valid Food Manager <br />Food Handler Card- Provide documentation that all employees have a valid California Food Handler Card. <br />Log- A written log must be maintained for a minimum of 90 days after each operation to include the event <br />❑ <br />organizer name and contact information, location of service, menu of foods and beverages served. When <br />operating at a host facility, the log shall include your menu and location/date/time of operation. Please <br />describe how you will log this information (i.e. What type of database) and provide a sample of that log. <br />1 RRR P Hn7pltnn Aupni ip I gtnrktnn (:alifnrnin Qr9nR IT 9M ArR_' dA?0 I F 9no ARd_n'13R I \MMN SIrinv nrnlphri <br />