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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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C
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CARROLTON
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19224
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2800 - Aboveground Petroleum Storage Program
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PR0529265
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BILLING
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Entry Properties
Last modified
11/2/2020 10:09:02 PM
Creation date
8/24/2018 7:45:58 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2800 - Aboveground Petroleum Storage Program
File Section
BILLING
RECORD_ID
PR0529265
FACILITY_ID
FA0017376
FACILITY_NAME
WES MCCANN
STREET_NUMBER
19224
Direction
S
STREET_NAME
CARROLTON
STREET_TYPE
RD
City
RIPON
Zip
95366
APN
24508029
SITE_LOCATION
19224 S CARROLTON RD RIPON
RECEIVED_DATE
10/23/2013
P_DISTRICT
004
QC Status
Pending
Supplemental fields
FilePath
\MIGRATIONS\C\CARROLTON\19224\PR0529265\BILLING\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
10/23/2013 8:00:00 AM
QuestysRecordID
2044061
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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SAN JOAQUIN COUNTY 'VIRONMENTAL HEALTH DEPAF IENT <br /> _ MASTERFILE RECORD INFORMATION FORM <br /> ❑ New EH Program at Existing Facility ❑New EH Program and New Fa 'fit <br /> Facility I Z 2 Program Record ID <br /> Facility Address ZZ- C 4&0 L'r0� <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 ❑ with 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 t0 ❑ Ice Plant <br /> ❑ Special Event Dates of operation from to ❑ Produce Stand <br /> DAIRY PROGRAM (2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser-Number of Containers in Multi-Head Unit <br /> CUPA ❑ State Facility Surcharge(2399) <br /> HAZARDOUS WASTE PROGRAM(2200) <br /> ❑ Hazardous Waste Generator----------- Tons Generated Per Year ❑ Recycle/Exempt System (2299) <br /> ❑ CRT Offsite Handlers(2218) --------- ❑ Silver Only(2222) ❑ Applianc Recyclers(2217) <br /> Tiered Permitting Facility--------------- ❑ Conditionally Authorized(CA) ❑ Condi do It Exempt(CE) <br /> ❑ Permit-By-Rule Fixed Unit ❑ Permi y-R I Household Hazardous Waste <br /> BOVEGROUND STORAGE TANK FACILITY(AST)(2390) Number of AST % <br /> NDERGROUND STORAGE TANK(UST)PROGRAM(2300) Use UST A and B for s <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 ❑ NPUSEP Cleanup Site ❑ UIC Site <br /> ❑ Abandoned HW Site ❑ non-NPLJSEP 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 /> ❑ Poultry Farm-----Maximum number of birds ❑ Kennel <br /> TATTOO, BODY PIERCING,PERMANENT COSMETIC PROGRAM (4100) <br /> ❑ Tattooing (4121) ❑ Body Piercing(4120) ❑ Permanent Cosmetics(4122) <br /> LIQUID WASTE PROGRAM (4200) <br /> ❑ Pumper Vehicle Registration# License# Capacity Vehicle# <br /> ❑ 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(#of Units) ❑ Dumpsters> 20 cu yd (n of 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 ❑ 11 - 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 PROGRAM <br /> CONTACT PERSON Day Ph Night Ph <br /> PROGRAM ELEMENT d FEE ❑ Surcharge FEE ❑ Other FEE <br /> INSPECTOR# i d PERMIT VALID t0 El <br /> Handler <br /> ❑ Check# AMOUNT PAID Date INVOICE# <br /> ❑ Cash REVIEWED BY ACCOUNTING OFFICE Date B 9 <br /> 48-02-034 MASTERFILE RECORD INFORMATION PINK <br /> 11/15/07 <br />
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