My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
BILLING
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
B
>
BIRD
>
23623
>
2800 - Aboveground Petroleum Storage Program
>
PR0538998
>
BILLING
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
12/15/2020 10:19:49 PM
Creation date
8/24/2018 7:40:35 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2800 - Aboveground Petroleum Storage Program
File Section
BILLING
RECORD_ID
PR0538998
PE
2831
FACILITY_ID
FA0019471
FACILITY_NAME
SHIMMICK CONSTRUCTION CO INC
STREET_NUMBER
23623
Direction
S
STREET_NAME
BIRD
STREET_TYPE
RD
City
TRACY
Zip
95304
APN
25010003
QC Status
Pending
Supplemental fields
FilePath
\MIGRATIONS\B\BIRD\23623\PR0538998\BILLING .PDF
QuestysFileName
BILLING
QuestysRecordDate
5/23/2017 6:01:17 PM
QuestysRecordID
3394318
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
4
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SANAQAQI II COUNTY IRONMENTAL HEALTH DEPA NT <br /> MASTERFILE RECORD INFORMATION FORM <br /> New EH Pro ram at Existing Facility ❑New EH Program and New Facility <br /> acility ID . Program Record ID <br /> Facility Address rP 1" s- `- <T,� Q <br /> (Please check the appropriate description and specify size, number of units and pertinent information.) <br /> FOOD PROGRAM(1600) <br /> ❑ Restaurant: Seating Capacity_ Square Footage Food Handlers Course required: YES ❑ No ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑Vending Machines Number of Units <br /> ❑ Retail Market----Square footage ❑ w/Meat Market only ❑ Multiple Departments❑ Prepackaged Goods Only <br /> ❑ Mobile Food Vehicle--Make Vehicle Type Color <br /> Registration# License# Sticker# <br /> ❑ Mobile Food Prep Unit--Make Vehicle Type Color <br /> Registration# License# Sticker# <br /> ❑ Temporary Food Facility--Dates of operation from to ❑ Ice Plant❑ Produce Stand <br /> ❑ Special Event---Dates of operation from to ❑ CFO ❑ A ❑ B <br /> DAIRY PROGRAM (2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser-Number of Containers in Multi-Head Unit_ <br /> CUPA <br /> ❑ Hazardous Materials Business Plan (1900) Number of chemicals: <br /> ❑ CalARP Program ❑ Program 1 Facility ❑ Program 2 Facility ❑ Program 3 Facility <br /> ❑ Hazardous Waste Generator(2200)----------> Tons Generated Per Year <br /> ❑ Tiered Permitting Facility-------> ❑ CA(2232) ❑ CE (2233, 2234, 2235, 2237) ❑ PBR(2231) ❑ PER HHW(2236) <br /> '52.Aboveground Storage Tank Facility(AST) (2800) Number of ASTs -137 <br /> ❑ Underground Storage Tank Program (UST) (2300) Use UST A and B forms <br /> ❑ Other CUPA Program <br /> HOUSING PROGRAM (2400) <br /> ❑ Hotel/Motel------Number of Units ❑ Jail or Exempt Institution ----Number of Units <br /> Employee Housing (2700) Use Employee Housing/Labor Camp Application Form <br /> SITE MITIGATION(2900) UNDERGROUND INJECTION CONTROL(3000) <br /> ❑ Environmental Assessment ❑ UST-CAP Site ❑ Local HW Cleanup Site ❑ NPLISEP Cleanup Site ❑ UIC Site <br /> ❑ Abandoned HW Site ❑ non-NPUSEP Cleanup Site ❑ RWQCB Cleanup Site ❑ Water Quality Remediation Site <br /> RECREATIONAL HEALTH PROGRAM(3600) <br /> Number of Pools/Spas at Facility_ ❑ Pool ❑ Spa ❑ Out of Service Pool/Spa ❑ Natural Bathing Area <br /> VECTOR CONTROL PROGRAM(4000) <br /> 13 Poultry Farm-------Maximum number of birds 11 Kennel <br /> TATTOO BODY PIERCING PERMANENT COSMETIC PROGRAM (4100) <br /> ❑ Body Art Practitioner Reg (4110) ❑ Mechanical DSPS Notification (4115) ❑ Body Art Facility-Single Use (4120) <br /> ❑ Body Art Facility-Sterilization (4121) ❑ Body Art Temp Event Co-ord (4130) ❑ Body Art-Temp Event Mobile Facility (4131) <br /> LIQUID WASTE PROGRAM (4200) <br /> 1:1 Pumper Vehicle Registration# License# Capacity Vehicle# <br /> 11 Pumper Yard ❑ Package Treatment Plant ❑ Chemical Toilets----Number of Units <br /> SOLID WASTE PROGRAM (4400) <br /> ❑ Landfill ❑ Transfer Station ❑ Ag/Cannery Waste Site ❑ Sludge/Ash Site <br /> ❑ Waste Tire Facility ❑ Compost Facility ❑ Process/Recycle Facility ❑ CIA Landfill Site <br /> ❑ Refuse Vehicles(#or units) ❑ Dumpsters> 20 cu yd (#or Units) ❑ Farm/Ranch Cleanup Site <br /> MEDICAL WASTE PROGRAM(4500) <br /> ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing ❑ Large Generator ❑ Small Generator ❑ Limited Hauler <br /> ❑ Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility ❑ 2- 10 011 -60 ❑ >60 generators <br /> PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Application Form <br /> EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRANigNig '<Y, ^� <br /> Da Ph o> '}—! ht Ph <br /> CONTACT PERSON Y <br /> PROGRAM ELEMENTS FEE .tel ❑ Surcharge FEE ❑ Other FEE <br /> INSPECTOR# �� tO PERMIT VALID �^SJ--� 10 '` J 1 ❑ Food Handler <br /> ❑ Check# AMOUNT PAID Date INVOICE# <br /> ❑ Cash REVIEWED BY ACCOUNTING OFFICE Date !11N <br /> 48-02-034 MASTERFILE RECORD INFORMPINK <br /> 1/23/13 <br />
The URL can be used to link to this page
Your browser does not support the video tag.