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4. Cleaning-Describe the procedures you will use to clean and sanitize food contact surfaces, equipment, and utensils at the commissary. dicate the specific sanitizer or sanitizing method that you will rise by checking the tax hplow: I Contact with a solution of 100 ppm (parts per trillion) available chlorine for at least 30 seconds. C-1 Contact with a solution of 200 Pm available quatemary ammonium for at least one(1) minute. check the option you will use: Corrrnefcial pre-mixed solution or❑ I will prepare my own sanitizer solution Statements Initial next to the below statements indicating that you understand and will abide by thertt- A Catering permit may be used to prepare and serve food at private events and host facilities only. `, 1 Operating at a Community Event or Certified Farmers'Market requires a separate health permit. All food must be prepared at the approved facility. Home prepwation of food is prohibited. Only �? 2 limited food preparation, as defined in California Retail Food Code {CRFC], is allowed at an off-site food service event- 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- All equipment, utensils and food related items shall not be stored in a private home when not 4 conducting catering activities. 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. Mechanical refrigeration is required to hold all potentially hazardous food during operation„use of ice,portable cooking blocks,or:chests/coolers is prohibited_ Li At the end of the operational period, all mlti-use utensils will be washed and sanitized at the 7 approved commissary- 8 Have access to potable water. i 9 All garbage, refuse and liquid waste will he disposed of in an approved manner as approved by the Atli— EHD_ -� 10 At the end of the operational period, all multi-use utensils will be washed and sanitized at the approved commissary/permitted food facility. Any food that has become contaminated, suspected of becoming contaminated or presumed 11 unsafe must be discarded. - Acknowledgment understand arxJ tixytee that tf I make --ranges tomyoperuling pmcPdures,l rivusi not fy Diu LlID within I days Failure to notify EHD of;any chanoes may result in susper;;i.�,n or revocation of the Health Permit ivwed to me to operate as a Calerinq Operation. Ensure approvals are obt - from all csble agencies prior to opemlion(e.g...fire,zoning. utc.) Authoriz(:d Signature: _ = C�ate: c� Print NameTitle; Jf d. TT i ;e ,Fi E. Hazelton Avenue I Stockton. California 95205 I T 209 468-3420 1 F 209 464-0138 1 www.Wehd.com 4