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Environmental Health Department <br />4. <br />Initial next to the below statements indicating that you understand and will abide by them. <br />1 <br />2 <br />3 <br />4 <br />NOTE: <br />(1^5 <br />6 <br />7 <br /> 8 <br />9 <br /> 10 <br />11 <br />Print Name: <br />A nf A <br />Statements <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 />SANJOAOUIN <br />-------COUNTY------- <br />Cleaning- Describe the procedures you will use to clean and sanitize food contact surfaces, equipment, <br />and utensils at the commissary. <br />Jk <br />Indicate the specific sanitizer or sanitizing method that you will use by checking the box below: <br />0zContact 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: GXommercial pre-mixed solution or I will prepare my own sanitizer solution <br />an approved manner as approved by the <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 />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 />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. <br />Operation at Host Facilities limited to four (4) hours in a twelve (12) hour period. <br />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 />At the end of the operational period, all multi-use utensils will be washed and sanitized at the <br />approved commissary. <br />Have access to potable water. <br />All garbage, refuse and liquid waste will be disposed of in <br />EHD. ___________________ <br />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 />Any food th athas 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 ° ac a ° β€˜ar,n2 n,ara ,n <br />approvals are obtained from all applicabjeacjepcz: 7 * <br /> Authorized Signature: β€” <br />) me to operate as a Catering Operation. Ensure <br />icies priopfo operation (e.g., fire, zoning, etc.). <br />Date: 17^-WT^ <br />Title: