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SANAOAQUIN <br />CT',S4`, —COUNTY <br />Greatness grows here. <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. <br />Catering Operation Name: The GiaZln l� U0 Facility ID#: <br />Business Owner Name: e reS61 KI a va rlro Phone a: 415 b Ob <br />E-mail:cA "P',� rltZln Irl E rn a i t• rn website (if applicable) In Cl <br />I <br />Mailing Address: 1495 Sereno Drive city; manit Ca <br />5 <br />Zip code: 9 5 3 3 7 <br />Documents to Include <br />✓ Check the fotlowin items asyou include them with this document. <br />pplication- Complete and submit the Service Request form. Ensure that all information is legible. <br />�(Commissary <br />Agreement- The Caterer must prepare and store all food and equipment at a commissary kitchen <br />u <br />(permitted food facility). The Catererand 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 />ales at a host facility. <br />Specification Sheets- Submit specification or cut sheets for your equipment, including the portable <br />mechanical refrigeration, overhead protection/enclosure, and portable hand -washing sink(s) carts that will <br />u <br />be utilized during a Catering event. Provide documentation that shows the certification for sanitation and <br />lectrical standards by an American National Standards Institute (ANSI) accredited certification program such <br />s 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 />Protection Manager Certification- Provide proof that an owner or employee has a valid Food Managecate. <br />ler Card- Provide documentation that all employees have a valid California Food Handler Card. <br />1[f <br />tten log must be maintained for a minimum of 90 days after each operation to include the event <br />name and contact information, location of service, menu of foods and beverages served. When <br />at a host facility, the log shall include your menu and location/date/time of operation. Please <br />ow you will log this information (i.e. What type of database) and provide a sample of that log. <br />EKCet 4. PQ Ct 10 <br />1. <br />1868 E. Hazelton Avenue I Stockton, California 95205 1 T 209 468-3420 1 F 209464-0138 J www.sjgov.org/ehd <br />