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rir <br />SANJOAQUIN <br /> • ' Environmental Health Department <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 />.2rContact with a solution of 100 ppm (parts per million) available chlorine for at least 30 seconds. <br />El Contact with a solution of 200 ppm available quaternary ammonium for at least one (1) minute. <br />Check the option you will use: LI Commercial pre-mixed solution or LI 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 />se _ 1 <br />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 />5C_ <br />2 <br />All food must be prepared at the approved facility. Home preparation of food is prohibited. Only <br />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 />SC- 4 All equipment, utensils and food related items shall not be stored in a private home when not <br />conducting catering activities. <br />6C 5 <br />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 />6C 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 />Sc 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 />SC 9 All garbage, refuse and liquid waste will be disposed of in an approved manner as approved by the <br />EHD. <br />sC-- 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 />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: 9 <br />Date: I/2# <br />Print Name: 511U A.C6( CaldeeKus Title: OtoVIeV <br />A nf A