Laserfiche WebLink
SAN J"OAQUIN COUNTY ENVIRONMENTAL HEALTH DLPARTII E <br /> MASTERFILE RECORD INFORMATION FORIA <br /> ❑New EH Program at Exist in Facility [I Now EH Program and New Facility <br /> Facility ID Program Record ID <br /> Facility Address 20 0 In; <br /> (Please Check the appropriate description and specify size'number of units and pertinent information") <br /> FOOD PROGRAV1(1600) <br /> F1 Restaurant: Seating Capacity Square Footage Food handlers Course required:. Yes El No <br /> ❑ Commissary ❑ Dry storage only Elwith 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 /> El Temporary Food Facility—Dates of operation from to El ice Plant <br /> El Special Event —Dates of operation from to El Produce Stand <br /> DAIRY PROGRAM(2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispeuser—Number of Containers is Multi-Head Unit <br /> COPA ❑ State Facility Surcharge(2399) <br /> iIAZARDOUS WASTE PROGRAM(2200) l <br /> ❑hazardous Waste Generator--- Tons Generated Per Year ❑Recycle f Exempt System(2299) <br /> ❑CRT Offsite Handlers(2218) ❑ Silver Only(2222) ❑ Appliance Recyclers(2217) <br /> Tiered Permitting Facility ❑ 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 AS T <br /> UNDERGROUND STORAGE TANK(UST)PROGRAM(2300)Use UST A and B(amts <br /> HOUSING PROGRAM(2400) <br /> ❑ notel/liiotel Number of Units ❑Jail or Exempt Institution Number of Units <br /> Employee Ilousiag(2700) Use Employee 11ousing/Labor Carp Application Form <br /> SITE MITIGATION(2900) UNDERGROUND INJECTION CONTROL(3000) <br /> ❑ Environmental Assessment ❑UST-CAP Site ❑Local IIW Cleanup Site, ❑NPL/SEP Cleanup Site ❑U1C Site <br /> ❑ Abandoned 11W Site ❑ Ron-NPIISEP Cleanup Site ❑RWQCB Cleanup Site ❑Water Quality Remediation Site " <br /> RECREATIONAL HEALTH- PROGRAM(3600) <br /> Number of Pools/Spas at Facility. ®Pool 11 spa ❑ Out of Service Pool/Spa ❑Natural Bathing Area <br /> VEGTOR CONTROL PROGRAM(4000) <br /> CI Poultry Farms 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 /> El Pumper Vehicle—Registration# License# Capacity Vehicle <br /> 11 Pumper Yard 11 Package Treatment Plant- ❑-Chemical Toilets Number of Units <br /> SOLID WASTE PROGRAM(44400) <br /> ❑ Landfill ❑ Transfer Station ❑Ag/CanneryWaste Site ❑ CIA-LandSludge/Aslfill <br /> Site <br /> Waste Tire Facility ❑ Compost Facility ❑ Process/Recycle Facility ❑ CIA•I andfill 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 Q Small Generator ❑ Limited hauler <br /> ❑ Transfer Station ❑Veteriaary Cliaic ❑ Common Storage Facility--E] 2-10 ❑ 11-60--❑>60 generators <br /> PUBLIC WATER SYSTEM PROGRAM(4600) Use Pff'SEHD 46-02-003 Blue Appfica6on Form <br /> EMERGENCY NOTIFICATION FOR THis FACILITY AND/Oft PROGRAM <br /> CONTACT PERSON Day Ph Night Ph _ <br /> PROGBAMELEMENT__t11--(C1 -f'FE ❑ SurcliargeFEE '- ElOtberFEE <br /> INSPFC-TOR _ PERMITVALID t0 El Food handler__ <br /> l 1 Check{{ A-MOUNT I AID _ Date 1PNOICE'(/ _ ---- <br /> -- - <br /> ❑ Cash R� VIEWF"D BY ACCOUNTING OFFICE Date �I/ — <br />