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EHD Program Facility Records by Street Name
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1240
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4700 - Waste Tire Program
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PR0523987
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Entry Properties
Last modified
2/26/2020 12:21:31 PM
Creation date
2/25/2020 2:15:31 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4700 - Waste Tire Program
File Section
BILLING
RECORD_ID
PR0523987
PE
4740
FACILITY_ID
FA0001304
FACILITY_NAME
STOCKTON SCAVENGERS ASSOCIATION
STREET_NUMBER
1240
STREET_NAME
NAVY
STREET_TYPE
DR
City
STOCKTON
Zip
95206
CURRENT_STATUS
02
SITE_LOCATION
1240 NAVY DR
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
CField
Tags
EHD - Public
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SAN JOAQUIN COUNTY ENVIONMENTAL HEALTH DEPARTMOT <br />MASTERFILE RECORD INFORMATION FORM <br />G[New EH Program at Existing Facility ❑New EH Program and New Facility <br />Facility ID t A LCC%i QL! Program Record ID <br />Facility Address (,D- `i t v' �� <br />(Please Check the appropriate description and specify size, number of units and pertinent information.) <br />FOOD PROGRAM (1600) <br />❑ Itestauranl: Seating Capacity Square Footage <br />❑ Commissary ❑ Dry storage only ❑ with Food Preparation <br />❑ Retail Market ---- Square footage ❑ with Meat Market only <br />❑ Mobile Food Vehicle -----Make Vehicle Type _ <br />Registration # License #_ <br />❑ Mobile Food Prep Unit -Make Vehicle Type _ <br />Registration # License #_ <br />❑ Temporary Food Facility ----- Dates of operation from <br />❑ Special Event -- Dates of operation from to_ <br />DAIRY PROGRAM (2000) <br />Food handlers Course required: l'Es ❑ No ❑ <br />❑Vending Machines --Number ol'Units <br />❑ Multiple Departments ❑ Prepackaged Goods Only <br />Color <br />Sticker # <br />Color <br />Sticker # <br />to <br />❑ Ice Plant <br />❑ Produce Stand <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) ❑ 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 (ASI') (2390) Numbcr of AST <br />UNDERGROUND STORAGE TANK (UST) PROGRAM (2300) Use USTA 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 11Local 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 <br />VECTOR CONTROL PROGRAM (4000) <br />❑ Poultry Farm -------Maximum number of birds _ <br />TATTOO. BODY PIERCING PERMANENT COSMETIC PROGRAM (4100 <br />❑ Spa ❑ Out of Service Pool/Spa ❑ Natural Bathing Area <br />❑ Tattooing (412 1) ❑ Body Piercing (4120) <br />LIQUID WASTE PROGRAM (4200) <br />❑ Pumper Vehicle -Registration # License # <br />❑ Pumper Yard ❑ Package Treatment Plant <br />SOLID WASTE PROGRAM (4400) <br />❑ Kennel <br />❑ Permanent Cosmetics (4122) <br />Capacity Vehicle # <br />❑ Chemical Toilets ------Number of Units <br />❑ Landfill ❑ Transfer Station ❑ Ag / Cannery Waste Site <br />E[ Waste Tire Facility ❑ Compost Facility ❑ Process/Recycle Facility <br />❑ Refuse Vehicles --Number of Units ❑ Dumpstcrs > 20 cu yd ----Numbcr of Units <br />❑ Sludge/Ash Site <br />❑ CIA Landfill Site <br />❑ Farm/Ranch Cleanup Site <br />MEDICAL WASTE PROGRAM (4500) <br />❑ Primary Care C1 Acute Care ❑ Skilled Nursing ❑ Large Generator El Small Generator 11 Limited Hauler <br />El Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility --- 1:1 2 - 10 ---- 13 1 1 - 60 -- El > 60 generators <br />PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 BlneAppliealion Form <br />EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM <br />CONTACT PERSON Day Ph Night Ph <br />PROGRAM EI,ENIEN'I' `I -N (- FEE _ <br />INSPECTOR # i+C (v C PERMIT VALID <br />❑ Check # _ <br />❑ Cash <br />48-02-034 <br />nri,nnm <br />AMOUNT PAID _ <br />REVIEWED BY Tr- 5A /0 S <br />❑ Surcharge FEF ❑ Other FEE _ <br />to ❑ Food Handler <br />Date <br />ACCOUNTING OFFICE <br />INVOICE # <br />Date <br />Masterfile Record Pink <br />
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