My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
BILLING
EnvironmentalHealth
>
EHD Program Facility Records by Street Name
>
Q
>
QUAIL LAKES
>
1904
>
1600 - Food Program
>
PR0544170
>
BILLING
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
3/22/2019 9:51:14 AM
Creation date
3/22/2019 9:50:54 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
BILLING
RECORD_ID
PR0544170
PE
1626
FACILITY_ID
FA0025112
FACILITY_NAME
QUAIL LAKES BAPTIST CHURCH
STREET_NUMBER
1904
STREET_NAME
QUAIL LAKES
STREET_TYPE
DR
City
STOCKTON
Zip
95207
CURRENT_STATUS
01
SITE_LOCATION
1904 QUAIL LAKES DR
P_LOCATION
01
QC Status
Approved
Scanner
JCastaneda
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
2
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT RA Y��iV7- <br /> MASTERFILE RECORD INFORMATION FORM <br /> Q_New EH Pro ram at Existin2 Facility ❑New EH Program and New FacilityC� <br /> Facility ID Program Record ID D5 1-a Sq ✓OAQU/ © 20j9 <br /> Facility Address �9u ��t s��� i- . F E �� �>'�Z�' Eye HRO%f"w-UNn, <br /> (Please check the appropriate description and specify size,number of units and pertinent information.) DEPARTMENT <br /> FOOD PROGRAM(1600) )) <br /> Restaurant: Seating Capacity I l Square Footage Food Handlers Course required: YES p No ❑ <br /> i <br /> J3 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) -------------El Silver Only(2222) ❑ Appliance Recyclers(2217) <br /> Tiered Permitting Facility -------------------El Conditionally Authorized(CA) ❑ Conditionally Exempt(CE) <br /> ❑ Permit-By-Rule Fixed Unit ❑ Permit-By-Rule 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 forms <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 ❑ NPL/SEP Cleanup Site ❑ UIC Site <br /> ❑ Abandoned HW Site ❑ non-NPL/SEP 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(#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 111��� {1I\4``���rJ��) Day Ph Night Ph <br /> PROGRAM ELEMENT 1 1 FEE q ❑ SurchaMe F5E ❑ Other FEE <br /> INSPECTOR# PERMIT VALID t0 2XI ElFood Handler <br /> /,// <br /> ❑ Check# 6L AMOUNT PAID T- -OV Date INVOICE# l0 T <br /> ❑ Cash REVIEWED BY ACCOUNTING OFFICE Date <br /> 48-02-034 MASTERFILE RECORD INFORMATION PINK <br /> 11/15/07 <br />
The URL can be used to link to this page
Your browser does not support the video tag.