Laserfiche WebLink
[ 'r <br /> SAI"I JOAQUIN COUi�IT�'�?Njr'IRUCdTitLN`I,�L HEALTH DEPAI"I'MENi' <br /> _ MASTEMLE REC01W INFORMATION FOrOl <br /> El New CH Program at Exu(in Facility llcvr F-11Frog m and Ncir I acili(y_ <br /> FFaFaciliO,ID_ Q -- — I rrant Record ID <br /> Facilit t- Address <br /> (Please Check the appropriate description and specify 5172,number of units and pertinent information) <br /> l=ODD PROGRAM(1600) <br /> El Restaurant: Seating CapacitySquare Footage Food lIa[idlers Course required: I'es ❑ No ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑\'ending Machines—Number of Units <br /> ❑ Retail Market—Square footage ❑ with 1:1cat lriarket only ❑ Multiple Departments ❑ Prepackaged Goods Only <br /> ❑ Mobile Food Vehicle---Make Vehicle Type Color <br /> Registration U License lr Sticker# <br /> ❑ Mobile Food Prep Unit—Make Vchicle Type Color <br /> Registration# License# Sticker.4 <br /> ❑ Temporary Food Facility--Dotes of operation from - to ❑ Ice I'lant <br /> ❑ Special Event --Dates of operation from to ❑ Produce Stand <br /> DAIRY PROGRAM (2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser—Numbcr of Container in Multi-llead Unit <br /> CUPA ❑ State Facility Surcharge(2399) <br /> HAZARDOUS WASTE PROGRAM(2200) I <br /> ❑hazardous Waste Generator-- Tons Generated Per Year ❑ Recycle/lE_enipt Systeni (2299) <br /> ❑ CRT Offsite handlers (2218) ❑ Silver Only(2222) ❑ Appliance P.ecyclers(2217) <br /> Tiered I'eriui(ting facility --❑ Conditionally Authorized(CA) ❑ Conditionally Exempt(CC) <br /> ❑ Permit-By-Rule Fixed Unit ❑ Pcrut-By-Rule Household Hazardous Waste <br /> ❑ ABOVEGROUND STORAGE TA111K FACILITY(AST)(2390) Number of AST <br /> UNDERGROUND STORAGE TANK(UST)PROGRAM(2300)Use U.STA and f; (arr,rs <br /> HOUSING PROGRAM(2400) <br /> ❑ IIotenilo(el Number of Units ❑ .Tail or Exempt Institution Number of Units <br /> Employee housing(2700) Use 1?rrrplapee Horrsirrr/IaGor Camp Applicatio«f=orm <br /> SITE MITIGATION(2900) UNDERGROUND IRIJECTIOht CONTROL(3000) <br /> [I Environmental Assessment ElUST-CAPSite 11 Local MV Cleanup Site. ❑ 1dPL/SEI'Cleauup Site El UlC site <br /> ❑ Abandoned IBB'Site ❑ non-NPLISEP Cleanup Site ❑RVN'QCB Cleanup Site ❑ Water Quality Remediation Site <br /> RECREATIONAL HEALTH PROGRAM(3600) <br /> Number of pools/Spa;at Facility ❑ Pool ❑ Spa ❑ Out of ScrNice PooUSpa ❑ Natural Bathing Arca <br /> VECTORCOHTROL PROGRAM(4000) <br /> ❑ Poultry Farm Maximum number of birds ❑Kennel <br /> TATTOO BODY PIERCHIG PERNIANEN T COSMET IG PROGRAM(4100) <br /> ❑ Tattooing(412 1) ❑ Body Piercing(4120) ❑ Perruaneat Cosmetics(4122) <br /> LIQUID WASTE_PROGRAM(4200) <br /> ❑ Pumper VPhicte—Registration 9- License N Capacity Vehicle 4 <br /> ❑ Pumper Yard ❑ Pact:age Treatment Plant ❑ Chemical Toilets Number of Units- <br /> SOLID WASTE PROGRAM(4400) <br /> ❑ Landfill ❑ Transfer Station ❑ Ag/Cauncry Waste Sitc ❑ Sludge/Ash Site <br /> bq Waste Tire F•aciIi0, ❑ Compost Facility ❑ Process(Recyele Facility ❑ CIA Landfill Site <br /> ❑ Refuse Vehicles—IZuniber of Units ❑ Dumpstcr>20 cu}'d —1-lumber of Units ❑ 'FarmJR2ach Cleanup Site <br /> VAEDICAL i'IAS T E PROGRAM(4$00) <br /> ❑ I'rimat-y Circ ❑ Acute Circ ❑ Skilled Hursing ❑ Large Generator ❑ Small Generator ❑ Limited hauler <br /> ❑ Transfer S(ation ❑ Veterinary Clinic ❑ Common Storage l acilit} --❑ 2 - 10---❑ 11 -60 -- ❑ 'b0 generators <br /> PUBLIC INATER SYSTEi:1 PROGRAM(4600) (Lc!W1 F1fl7 AE-02-007 fllric-Arf ca(iorn Furru <br /> E IECGEHCY 00 TiFICA T ION FOR THIS F;aCILi T Y ,Awr)1or,PROGRAM <br /> CONTACT'I'Flt-SON Day Pit Ph <br /> I'RUG[?,M FLi-:Mt?I�T y1 Q0 h —1-L —❑ Surcharge FEL i-- — ❑ U(her 17EF — --_--- <br /> rECTpr,Y �- 1't:I I,tITVAI_ID -T it ❑ Food lfandlcr —._--- <br /> ❑ t I ;iAtr11 NT I',ti: It /Of(�///� <br /> C - `__� <br /> -- i --- <br />