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Sep. 16, 2022 2 : 30PM No. 0369 P. 3 <br /> SA NUJ 0 A Q U I N Environmental .Health Department <br /> --••COUNTY-- <br /> ;;o a Greotnesa grows here. <br /> All documents listed below must he submitted to the San Joaquin County Environmental Health Department <br /> (EMD) 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:, ��SS ey/cam//�//�S Facility IPq: <br /> l;usiness Owner Name; `)/y Ce 00ne,SR- Phone 9; l`'1, I� �F ` Q�7 <br /> E-mpll: /ss—✓odlm t� 01�'/�• e"` Website(If applicable) /`r 1`t' <br /> MaliingAddress; (r, li ` City[ Zip Code: aL � <br /> D • to • - <br /> I ✓ Check the following Items as you Include them with this document. <br /> Application-Complete and submit the Service Request form.Ensure that all Information Is legible. <br /> ❑ Commissary Agreement-The Caterer must prepare and store all food and equipment at a commissary kitchen <br /> (permitted food facility).The Caterer and their proposed commissary must complete and sign the commissary <br /> reg <br /> ent,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 /> be utilized during a Catering event, Provide documentation that shows the certification for sanitation and <br /> electrical standards by an American National Standards Institute(ANSI)accredited certification program such <br /> as 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 /> ❑ Food Protection Manager Certification.Provide proof that an owner or employee has a valid Food Manager <br /> certificate, <br /> ❑ Food Handler Card- Provide documentation that all employees have a valid California Food Handler Card, <br /> Log-A written log must be maintained for a minimum of 90 days after each operation to Include the event <br /> organizer name and contact Information, location of service, menu of foods and beverages served, When <br /> Aerating at a host facility, the log shall Include your menu and location/date/time of operation, Please <br /> describe how you will log this Information(I.e, What type of database)and provide a sample of that log. <br /> 1 <br /> 1868 E, Hazelton Avenue 1 Stockton, California 95205 I T 209 46a-34201 F 209 464-0138 1 Www.Sj9ov.or9/ehd <br />