Laserfiche WebLink
SAN JOAQUIN COUNTY ENVIRONNIEN`l'AL 11EAL'1'll DEI)AR'I'MEN1' <br /> • MASTERFILE R RD INFORMATION FORM <br /> ❑ New EH Pro ram at Existing FacilitX ❑New EI-1 Program and New Facilit <br /> Facilit ID C) (S Pro rata Record Ill � S'�(� v D <br /> Facility Address MG,-kms+ t_�j,, -A 3(, - q 30 <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 11 License# Sticker# <br /> ❑ Mobile Food Prep Unit--Make Velticle'I'ypc Color <br /> Registration it _ _ _ _ _ License 11 _ Sticker It <br /> ❑ Temporary l�'ood Faclllty---=-Dates ol'operution from to ❑ Ice Plant <br /> ❑ Special Event --Dates of operation from to ❑ Produce Stand <br /> PAs T I R SHOP rX0000®�o00®OOOo�- - <br /> LA LLANTERA 0 La Llantera/ Tire Shop <br /> lerate( 0 5023 N.Market St. 99) <br /> Oril, Linden,CA 95236 <br /> LLANTAS NUEVAS Y USADAS tional.' 0 <br /> 5023 N. Market St. FERNANDO ANGEL t-By-I ® ® Is Waste <br /> Mail: P.O. Box 783 Shop: (209) 887-2562 )(239 �I Shop Hrs: 0 <br /> M(23 0 Pedro Botello Mon-Fri:8-5 pm 0 <br /> Linden, CA 95236 Cell: (209) 981-7594 0 (209)887-3584 ` Sat:8-4 pm <br /> •• . • - ►i • i i • 060000000000060060 <br /> Employee housing(2700)Use En►nloyee 11ousinglLabor Cantu Applicatic.. . .... <br /> aROUMI<1 INJECTION CONTROL 3000) <br /> LA LLANTERA IMOBILE SERVICE - :alH -r� ye <br /> 24H S . ILII <br /> R®AD SERVICE pa ; 'ea <br /> _.- ;;ill �► 'v; r I <br /> �811 I PII RA1NIWhIICIIIII , 4121- 3 N Marke`ttt. Angel <br /> NEW and USED Mail: P.O. qox 783 Shop: (209)887-2562 <br /> Lindelre,X952�M' Cell: (209)981-7594 <br /> Cell(2091981-7594 CO 1793613479it <br /> t <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--Number of Units ❑ Dumpsters>20 cu yd ----Number 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 P{VS THD 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 ��Lf_v FEE ❑ Surcharge FEE ❑ Other FEE <br /> INSPECTOR# PERMITVALID -711 0 Y to x(30/0' ❑ Food Handler <br /> ❑ Check# AMOUN' ate INVOICE# <br /> ❑ Cash REVIEWED BY ACCOUNTING OFFICE Date ('LlC� <br /> 48-02-034 Masterfile Record Pink <br /> 11/18/03 <br />