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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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CLINTON SOUTH
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13959
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2800 - Aboveground Petroleum Storage Program
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PR0530297
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BILLING
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Entry Properties
Last modified
1/27/2021 10:13:32 PM
Creation date
8/24/2018 7:48:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2800 - Aboveground Petroleum Storage Program
File Section
BILLING
RECORD_ID
PR0530297
FACILITY_ID
FA0016881
FACILITY_NAME
CHUCK HOLLANDER
STREET_NUMBER
13959
Direction
E
STREET_NAME
CLINTON SOUTH
STREET_TYPE
AVE
City
RIPON
Zip
95366
APN
24516022
SITE_LOCATION
13959 E CLINTON SOUTH AVE
RECEIVED_DATE
10/25/2013
P_DISTRICT
004
QC Status
Pending
Supplemental fields
FilePath
\MIGRATIONS\C\CLINTON SOUTH\13959\PR0530297\BILLING\BILLING.PDF
QuestysFileName
BILLING
QuestysRecordDate
10/25/2013 8:00:00 AM
QuestysRecordID
2044506
QuestysRecordType
12
QuestysStateID
1
Tags
EHD - Public
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SAN JOAQUIN COUNTY IVIRONMENTAL HEALTH DEPAFTENT <br /> MASTERFILE RECORD INFORMATION FORM ..r <br /> ❑ New EH Pro ram at Existing acility ❑New EH Program and New Faac <br /> FacilityID 6 / Pro ram Record ID /lei 0'2 ilit <br /> Facility Address /3 9 5 S- C L Iry iorJ <br /> (Please check the appropriate description and specify size, number of units and pertinent information.) <br /> FOOD PROGRAM (1600) <br /> ❑ Restaurant: Sealing 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 to ❑ 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) ❑ Appliance Recyclers(2217) <br /> Tiered Permitting Facility------------------- ❑ Conditionally Authorized(CA) ❑ Conditionall Exempt(CE) <br /> ❑ Permit-By-Rule Fixed Unit ❑ Permit- ul Household Hazardous Waste <br /> ABOVEGROUND STORAGE TANK FACILITY(AST)(2390) Number of AST <br /> UNDERGROUND STORAGE TANK (UST) PROGRAM (2300) Use UST A and B form Z <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-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 fa of u,:1s, ❑ 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 1:12 - 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 /> PLI�NSPECTOR#2743 <br /> ELEMENT C7 FEE ❑ Surcharge FEE ❑ Other FEE <br /> PERMIT VALID l0 ❑ Food Handler AMOUNT PAID Date INVOICE# <br /> REVIEWED BY ACCOUNTING OFFICE Date 6 <br /> T <br /> 48-02-034 MASTERFILE RECORD INFORMATION PINK <br /> 11/15/07 <br />
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