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10/20/2005 16: 49 4640138 ENVIP.ONh1ENTAL HFAI'TH PAGE 03 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT MASTERFILE RECORD INFORMATION FORINT ❑New EH Provgrarn at Existing Facility nNcw EH ProgM and New Facili Facili ID fA 1) 0 1 L, L, I Pro am Record ID P�-o S7-474 Z— Facility Address 243 West Fremont Street. Stockton CA 95203 (please Check the appropriatc description and specify size,number of units and pertinent Information.) FOOD PROGRAM(1600) ❑);restaurant: Seating Capacity 0 Square Footage 0 Food Handlers Course required: S'ss❑ No ❑ ❑ commissary ❑Dry storage only ❑ with Food Preparation ❑Vending Machines Number of Units ❑Retail Market---Squats footage ❑ with Meat Market only [3 Multiple Departments ❑ prtpackaged Goods Only ❑ Mobile Food Vehicle---Make Vehicle Type Color Registration# License# Sti cker# ❑ Mobile Food Prep Unit--Make Vehicic Type Color Registration# License# Sticker# 11 Temporary Food Facility—Dates of operation from to ❑ Ice Plant F] Speeial.Event —Dates of operation from to El Produce Stand DAIRY PROGRAM(2000) C][A Grade A Dairy Grade R Dairy r] N1111k D4"ser---Number of Containers in Multi-Head Unit CUPA ❑ State Faclllty Surcharge(2399) HAZARDOUS WASTE PROGRAM(2200) ❑ Ilizardous Waste Generator— - ------Tons Generated Per Year Cl Recycle/Exempt System(2249) 0 CRT Offsite Handlers(2218) ❑ SiiN`er Only( 222) ❑Appliance Reeyclers(2217) Tiered Permitting Facility ❑ Conditionally Authorized(CA) ❑ ConditionaUy Exempt(CE) Q Permit-By-Rule Fixed Unit ❑ Permit-By-Rule Household Hazardous Waste C]ABOVEGROUND STORAGE TANK FACILITY(AST)(2390) Number of AST UNDERGROUND STORAGE TANK(UST)PROGRAM(2300)Use jLyjA and Borms HOUSING PROGRAM(2400) ❑ HotelfiNotel -Numbex of Units El Jad or Exempt Institution—Number of Units Employee Housing(2700) Use Emrfotre Housir+r/Labor Camp AyDllcalioR Form SITE lmGATION(2900) UNDERGROUND INJECTION CONTRO_L(3000) ❑ UIC Site [l LOCO HW Cleans Site ❑ NPL/SEP Cleanup Site ❑ Environmental Assessment ❑ UST-CAP Site p ❑ Abandoned HW Site ❑ non-NPL/SFP Cleagup Site ❑RWQCB Cleanup Site ❑Nater QuIlIty Remcdlation Site RECREATIONAL HEALTH PROGRAM(34600) Number of Pools/Spas at Facility ❑ Pool ❑ Spa Ll out of Service pooUSpa ❑Natural Bathing Arra VECTOR CONT OL PROGRAM(4000) ❑ Kennel ❑ Poultry Farm Maximum number of birds TTA 00.13ODY PIERC 1K©.PERMANENT COSMETIC PROGRAM(4101) © permanent Cosmetic%(4122) ❑ Tattooing(412 1) ❑ Body Piercing(4120) LIAUIDWAST13 PROGRAM(4200) Vehicle 0 ❑ Pumper Vehicle—Registration# License 9 Capacity ❑ puttaper Yard ❑ Package Treatment Plant ❑ Chemical Toilets Number of Units SOLID WASTE PROGRAM(4400) ❑ Sludge/Ash Site 11 Landfill LJ Transfer Station ❑ pr/Cannery Waste Site ❑ proces_R/Rcle Facility ❑ CIA Landfill Site [3 Waste Tire Facility El Compost Facility ecy ❑ Farrn/Ranch Cleanup Site ❑ Refuse Vebides--Number of Units ❑ Dumpstcts>20 cu yd--Number of Units MEDICAL WASTE PROGRAM(4500) c Generator ❑ Shall Generator ❑Limited 14auler ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing (]Lary ❑ ]1 -GO—060 generators ❑Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility----❑ 2- 10 PUBLIC WATER SYSTEM PROGRAM(4600)Usc PWS FTND 46--112-003 Slue A lien Form EMERGENCY NOTIriCATION FOR THIS FACILITY AHD/oR RROGRAM 209 518 8154 CON-TACT PERSON Patrick Bluso Day Ph (209) 518-8154 Night Ph rr ❑ Other FEF pROGRAhIEI.EME,,rr �k Z _ FF . ZZt7 ❑ SurchargeF>?E�/I __ JN,Sf"�cTOR# C)t q hLRMIT VALID y�Q L C S _ to 1�(31 I e ❑Food Handier �1�hcck 1t I / AMOUNT PAIn — Date l- f1 C 1,wo[CE Cash REvmwmsy AccowrINGOFFICE Datc Y Q