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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> MASTERFILE RECORD INFORMATION FORM <br /> 7 <br /> (Please check the appropriate description and specify size. number Of units and pertinent inforMation.) <br /> FOOD PROGRAM (10OO) <br /> [] Restaurant] Seating Capacity_____ Square Footage Food Handlers course[equireci: YES El No [] <br /> [] Commissary [] Dry storage only [] with Food Preparation []YondingMachines Number ofUnits <br /> [] Retail Market----Square footage [] vvlMeo1Market only [] Klu|Up|oDepsnn`*ntn [] Prepackaged <br /> Goods Only <br /> ---------' <br /> Elhqobi|oFoodYohido—Make Vehicle Type Color <br /> Registration# Licenso# Sticker# <br /> [] Mobile Food Prep Unit—Make Vehicle Type Coln, <br /> Registration# Lioenxe# Sticker# <br /> [] ����------- <br /> Temporary Food Facility D 1eanf operation f mm 10 ����------- <br /> LJ Ice Plant [] Produce Stand <br /> [ Speoi |'Event Dates of openaUonfnm 10 <br /> L] CFO [] A [] B <br /> DAIRY PROGRAM (znno) <br /> [] Grade A Dairy [] Grade B Dairy [] Milk Diopenoer'NomberofContainers in 0u|8-Head Unit_____ <br /> CUPA <br /> ]!�HazardounMaterials Business Plan (19OO) Number ofckemica|s- «=� <br /> LJ Ca|ARPProgrom [] Program 1 Facility [] Program 2Facility [] Program 3Facility <br /> [] Hazardous Waste Generator (2200)----------> Tons Generated Pei-Yew <br /> [] Tiered Permitting Facility -------> [] CA /2232) [] CE (22J8, 2234 22352237) [] PBR /223/) [] PBnHHVY '2Z-(�, <br /> [] Aboveground Storage Tank Facility (AST) (2800) Numberof43Ts_________ <br /> [] Underground Storage Tank Program (UST) (2300) Use <br /> [] Othn,CUPA Program <br /> HOUSING PROGRAM �24O0) <br /> [] Hotel/Motel------Numbe,nfUnits [] Jail orExempt Institution ----NmnberofUnits <br /> _________ <br /> Emv|oyooHousing (27/OO) Use Employee HOLISinglLabor Camp Application Fonn <br /> SITE MITIGATION (2900) UNDERGROUND INJECTION CONTROL (3000) <br /> [] Environmental Assessment [] UST'CAPSite [] Local HW Cleanup Site [] NPL/SEP Cleanup Site [] U|C Site <br /> [] Abandoned HVVSite [] non'NPL/SEPC|oanup Site [] RVYQCB Cleanup Site [] Water Quality RemediadonSite <br /> RECREATIONAL HEALTH PROGRAM (3OOO) <br /> NumhorofPools/Spas o\ Facility El Pool [] Spa [] Out ofService Pool/Spa [] Natural Bathing Area <br /> VECTOR CONTROL PROGRAM (4O00) <br /> [] Poultry Farm-------0aximun` numhe/ of birds [] Kennel <br /> TATTOO. BODY PIERCING.PERMANENT COSMETIC PROGRAM <41OO/ <br /> LJ Body Art Practitioner Reg (411O) [] rVieuhanioa| D8PSNotification (4115) [] Body Art Facility-Single Use <412O/ <br /> LJBody Art Facility-Sterilization (4121) [] Body Art Temp Event Co'on1 (4130/ [] Body Art-TompEvent Mobile Facility <41S1. <br /> LIQUID WASTE PROGRAM (42O0) <br /> El Pumper VehicheReg isoration# License# Capacity Vnhide#_________ <br /> [] Pumper Yard [] Package Treatment Plant [] Chemical Toilets --NumbernfUnito <br /> SOLID WASTE PROGRAM (44O0) <br /> LJ Landfill [] Transfer Station [] Ag/Cannery Waste Site [] S|udgeA\ehSho <br /> LJ Waste Tire Facility [] Compost Facility [] Process/Recycle Facility [] CIA Landfill Site <br /> LJ Refuse Vehicles (�-o,,unite, [] Dumpstnrep2OCLI yd o.,,` [] Fonn/RanuhCleanup Site <br /> hhEDICAL WASTE PROGRAM <450O/ <br /> [] Primary Care [] Acute Care [] Skilled Nursing [] Large Generator [] Small Generator [] Limited Hauler <br /> [] Transfer Station [] Veterinary Clinic [] Common Storage Facility [] 2 10 [] 1 | OO [] p OOgenerators <br /> PUBLIC WATER SYSTEM PROGRAM (4600) Use Fnnn <br /> EIVIERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM <br /> C014TACTPER5ON Day Ph Night Ph <br />