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Environmental Health Department SAN JOAQUIN C C)UNTv will use to clean and sanitize food contact surfaces,equipment, 4. Cleaning-Describe the procedures you ' and utensils at the commissary. Indicate the specific sanitizer or sanitizing method that you will use by checking the box below: - ❑Lontact with a solution of 100 ppm(parts per million)available chlorine for at least 30 seconds. Contact with a solution of 200o pm available quaternary ammonium for at least one(1)minute. Check the option you will use: Lis Commercial pre-mixed solution or L]I will prepare my own sanitizer solution statements Initial next to the below statements indicating that you understand and will abide by them. A Catering permit may be used to prepare and serve food at private events and host facilities only. VS 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 preparation of food is prohibited. Only 2 limited food preparation,as defined in California Retail Food Code(CRFC),is allowed at an off-site VS food service event. VS When operating at an off-sfte toad service event,a sign or bu 3siness cards must be posted/provided at the event premises stating the Caterers business name and address. VS 4 All equipment, utensils and food related items shall not be stored in a private home when not conducting catering aRivfties. j C Upon request,you must provide your operation schedule to END for inspection purposes. NOTE: It �r7 5 Operation at Host Facilities limited to four(4)hours in a twelve(12)hour period. [, VCv 6 Mechanical refrigeration is required to hold all potentially hazardous food during operation;use of ice,portable cooling blocks,or ice chests/coolers fs prohibited. VS 7 At the end of the operational period, all multi-use utensils will be washed and sanitized at the approved[ommfssary. V 8 Have access to potable water. V) g All garbage,refuse and liquid waste will be disposed of in an approved manner as approved by the END. U5 10 At the end of the operational period, all multi-use utensils will be washed and sanitized at the approved commissary/permitted food facility. _ 11 Any food that has become contaminated,suspected of becoming contaminated or presumed unsafe must be discarded. Acknowledgment i understand and agree that it I make changes to my operating procedures,I must notify the END within 7 days Failure to notify END F of any changes may result in suspension or revocation of the Health Permit issued to me to operate as a Catering Operation.Ensure approvals are obtained from all applicable agencies prior to operation(e.g.,fire,zoning,etc.). a..) r� /AP �� Authorized Signature: Date: I I / K l 9, Print Name: L a ttrA t/•T Soil-etc Title:fjVV Kf V �4:�C t'LC. I zw AMA