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Jan 18 08 11 : 07a Don Cash 520-q84-4619 p. 3 <br /> 18-Jan-2008 08: 59 AM Sun ate Equip Stockton CA 209463( 1 3/3 <br /> SAN JOAQUIN C0VN7x L"TRONKENI`AL HEALTH DuPARTME,NT ZU7 <br /> MAS"1TRME nF,CORD Il�I1[to1uYlATl0i4 FORM 7p�.7(�G�/� <br /> ❑Ncw E111'ro at Existi Facility 'QANe w)i P and Now Facility ` <br /> program Record 1D ^OW-5 ) <br /> FxciIit M 3 <br /> Facility Address _7:�C EQu�Psiz.��•�_r c'ett2T F,�' p <br /> (Pie=Cheek the appralrriate description and spceify numbcr of units need nerlingnt inforMalion.) <br /> Foop ROGRA (1600) <br /> ❑Restaurant: Seating f apacity Square 17,14ge�, - Food handl=e:Course reQaireds- Yas o No t3 <br /> Q pry storage only 0 with Iwai Weparatioa ElVendina-macl�iaes--Number of Units <br /> ❑Commisssr? - [3 Pec aeko cd Goods Only <br /> D Rd It MArket--squire footage with Meat Market only Q Multiple J3cpattrncau P g y <br /> V-JtickTypc Color <br /> Q Mobile Food Vehicle---Ma1Ce ucmsc# Sticker# <br /> RegisUation# Colo[ <br /> 13 Mobile Food PrcP 1Jnit--Make Yducie lypc <br /> Liaaso d Sticiccr# <br /> Ttegistmtion# to <br /> ❑Te Food Fap'Iigr----Dales -f opciation front to Produce Stand <br /> Ll Special Evcat -Dates ofoperation from <br /> DAIRY pROG M(� ) O IvM—DiRwascr-Natnber vfCocttairtcts is Muni-Hc1d Unit <br /> Ll GradcADatrp L7 Grade$Dairy <br /> GUPA &Slate Fadll(y Strcltxrge(7.399) <br /> IIAItDOVS WASTE PROGRAM 92", { <br /> ' �. �$' •p Recycle/Ezexttpt S}^stem(2.299) <br /> 19 hazardous Waste Geamtor- ----Tons Genvted Pcr Year Ll ArFUancc Rccycl«s(2217) <br /> CRT Offsite:H=dlm(2218) 0 Silva Only(2222) <br /> � <br /> Fxc�ity-�- 0 C.aditit-Uy Anth-ewc'.d(CA) U CouditionaUy E=wPt(CS) <br /> Tiered Permitting Tax <br /> q pcxmit y-Retic ed Uuii U permit-By-Rule,Houselw1d HRzardous Wast" <br /> . � �cnd�� �opTAC �pnU sroE NK UM PDxRAR(230o)u AR rulms <br /> NOU5lt4q 3 J <br /> p OGKAM(2400) of Units <br /> Lj 110temotd Numbcr of Units -_._ ❑Jail or Exempt Institution—H <br /> Eatp[o7xHsrsta=(27W)Use�""� yscHousing2aborCamp ipg(ro¢fAForm <br /> SITE 141pTIGA QK(?900) UND tWo tNSECTION GONi'RO ) <br /> C3 Eavtrontnent A41SSc sme:at [3UST-C-0 Site G I.vcatlXW RNVQ p SCte. <br /> Q jdPL{SEP Cicaaap Site p UIC Site <br /> 11 Ahandoncd II'1V Site E3 ,n-NPL=V Cleaavp Site G3 RR'QCII Cleanup Site Q Nater Qttaiity Remediation Site <br /> 1tCCRF11TIr1NALHEALTHP OGRAM(3000) l�palofScrri ;'ooUSlnt OPlatIIralk;athiagArra <br /> Nu:siba ofFooislSpas act-acty. Ci root Q sPa cc <br /> VECTOR CO OL p o M(4000) Q Kcaael <br /> [I roultry F&rm Matimumn=ber of birds <br /> T T7'OP gOA p - KG FEKNIAlfE f ds IC pROG M(4ifl0} (]permanent Cosmetics(417.2) <br /> 0 Tattooing(4121) C]Bodq Piercing(4120) <br /> 1_1QU1D WAsTv PROGRAM(4200 Yohiele# <br /> Pumper Vchick-Registn400# I iexaselE �P tY <br /> EJ pampa=Xard ©PaclsgeTreatmentPlan6 L)ChcmiealToilets----NumlxrofUnim <br /> s LAD v4AM POGRAM(4400) A 1 Cannery Waste Sit"- ❑SludgdAsta Site <br /> D Landfill C7 TrauderStation gp C�yapdGll Site <br /> ❑tiYasteTirc Facility ❑Cu'mpost Facility ❑ProccssJReeycle Faexiltp <br /> Ll Refuse Vehicles-Number of Units <br /> Dumpsi=>20 cu),,d Plumber of Units Q Farmaunclt Cicaaap Site <br /> MEDICAL WASTE pkgoRAM(4500) <br /> Cl Primary hire Q Acatc Cats C3 Sidifted Narsucg ❑Large Generator C3 Stnali Generator U Limited erator r <br /> ©Transfer Station ❑Vtteriamy Chair Q Common Storage P'acTjty--�2-10 <br /> GO--'-�>GO geelcrntots <br /> PUBLIC W TW SYSTEM Egon m(46�Use '11'S fiI{P I6-0MO; ue A t<rari0rr Fon,= <br /> <br /> <br /> <br /> <br /> PRootzwnt ELEMEh'Y' FsE----- <br /> ❑Sutrharge F __ ❑Other FEE <br /> PgRMlTVAUD . to C1 FoodT,iandlor <br /> INSPF.G'I"Oat# IrtVOICt'� <br /> (zx�tc a r AMOUNT PAID Date <br /> A000t war,a 0 E pate <br /> c.:h <br />