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Environmental Health Department <br />10. <br />11. <br />OR for rinsing and one for a bleach <br />12. <br /> One separate tub (bucket or basin) for the collection of rinse/wastewater. <br /> Paper towels and pump-style soap container. <br />13. <br />14. <br />Signature <br />Health Permit <br />Paper Hand Towels <br />Soap dispenser <br />Cutting Board <br />Bleach <br />Propane Stove <br />Propane Tank <br />Fire Extinguishera <br />Ice Cooler <br />Page 8 of 11 <br />Extra Ice Bags & Food Containers must be <br />stored 6 inches ott of the ground1 <br />Stemo w/Chatfing <br />Dish <br />5 Gal Hand wash <br />Wastewater Container <br />Garbage <br />Can <br />Sanitizer bucket­ <br />bleach & water for <br />storing wiping cloths <br />5-20 Gal. <br />Hand wash Water <br />Booth must be on <br /> Concrete, Asphalt, <br />Plywood, or a Tarp. <br />1868 E. <br />EHD 16-02 <br />06/19/19 <br />President <br />Title <br />Soap and Water Rinse Water <br />I am providing the following items within my booth for the sanitary cleaning of food preparation utensil <br /> Three compartment sink. <br />Names of responsible persons to be present in booth during all hours of operation: <br />KapilDev Kusari Contact No (415) 939-5652------------------------------------------ <br />‘‘Important** <br />9/8/2025 <br />Date <br /> Three deep tubs (basins 6-8 inches minimum), one for soapy water, one <br />solution (one tablespoon of bleach per gallon of water). <br /> Detergent, bleach, and wiping cloths (cleaning towels). <br /> Tub to store wiping cloths in bleach solution. <br />I am providing the following for adequate hand washing facilities, but separate from utensil wash within my <br />booth: <br /> Water supply dispenser with warm water at a minimum of 1 GOT (i.e. 5-20 gallon container with spigot). <br />SAN JOAQUIN <br />------COUNTY------- <br />Greatness grows here <br />I am providing the following cold temperature control for the cold holding of potentially hazardous foods below <br />45°F (if food is used the following day, maintain below 41°F temperature): <br />Ice chests Refrigerator <br />0 Refrigerated truck D Ice bath and tubs <br /> Other (specify)___________ <br />All food vendor booths are subject to inspection. Please make a copy of this application in <br />preparation for this event. A copy of this checklist must be in the booth at all hours of <br />preparation and operation. Return original to festival coordinator three weeks pr.or_to <br />this event. <br />Completed by: Sama Acharya <br />l=]ll <br />Hazelton Avenue | Stockton, California 95205 | T 209 468-3420 | F 209 464-0138 | www.sjgov.org^ehd^ <br />Extra <br />Water