Laserfiche WebLink
SAN J"OAQUIN 'COUNTY ENVIRONIMEN,rAL HEALTH DEPAIt'I M LN"1 <br /> MASTERFILE RE,CORD INFORMATION F0101 <br /> Wl`lew Eli Program at Exisfia2 Facility _ ❑tic•v Ell Program and New Facility <br /> Facility ID r4COOL(500 I'r,0 7ran>Record``ID <br /> Facility Address a gG is- <br /> (Please Check the appropriate description and specify s c number of units and pertinent information.) <br /> FOOD PROGRAM(1600) <br /> ❑Restaurant: Seating Capacity Square Footage Food Ilandlers Course required: YES ❑ No ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑Vending Nlacbiocs—Number of Units <br /> ❑ Retail Market—Square footage ❑-widi Nicat Market only ❑ Multiple Departments ❑ Prepackaged Goods Only <br /> ❑ Atobi(e Food Vehicle--Ntake Vehicle Type Color <br /> Registration# License# Sticker 11 <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 ❑Milt Dispenser--Numbcr of Container in Multi-Head Unit <br /> CUPA ❑ Slate Facility Surcharge(2399) <br /> HAZARDOUS WASTE PROGItAN1(2200) 1 <br /> ❑ Ilarardous Waste Generator-- Tons Generated Per Year ❑ Recycle IEiempt S)stem(2299) <br /> ❑ CRT Offsite Handlers(221€) ❑ Silver Only(2222) ❑ Appliance Recyclers(2217) <br /> Tiered Permitting Facility ❑ Conditioually Authorized(CA) ❑ Conditionally Exempt(CE) <br /> ❑Perruit-By-Rule Fixed Unit ❑ Pemut-By-Eula Household Hazardous Waste <br /> ❑ ABOVEGROUND STORAGE TANI`FACILITY(AST)(2390) Number of AST <br /> UNDERGROUND STORAGE TANK(UST)PROGRAM(2300)Use UST A and B(arras <br /> HOUSING PROGRAM(2400) <br /> ❑ Hotenlotel Number of Units 11 Jail or Exempt Institution—Number of Units <br /> EmployeeIlousing(2700) Usc1,mplopce Ifousirrp/Labor Camp Applicaeiorr Form <br /> SITE MITIGATION(2900) UNDERGROUND INJECTION CONTROL(3000) <br /> ❑ EciAronmeatal Assessment ❑ UST-CAP Site ❑ Local IBV Cleanup Site I NPIJSEP Cleanup Site ❑ UIC Site <br /> ❑ Abandoned IIII'Site ❑ non-NPL/SEP Cleanup Site ❑1� rQCB Cleaaup Site ❑ iVater Quality Remediation Site <br /> RECREATIONAL HEALTH PROGRAM(3600) <br /> Number of Pools/Spas at Facility ❑ Pool El Spa 11 Out of Senice PoollSpa ❑ Natural Bathing Area <br /> VECTOR CONTROL PROGRAM(4000) <br /> ❑Poultry Farm Maximum number of birds ❑ Kennel <br /> TATTOO,BODY PIE=RCING,PERMANENT COSMETIC PROGRAM(4100) <br /> ❑ Tattooing(412 1) ❑ Body Piercing(4120) ❑ Pertuaaent Cosmetics(4122) <br /> LIQUID WASTE PROGRAM(4200) <br /> ❑Pumper Vehicle—Registration I 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 ❑ I'rocesslRecycle Facility ❑ CIA Landfill Site. <br /> ❑ Refuse Vehicles—Nun-tbcr of Units — ❑ Dumpsters>20 cu yd —Number of Units ❑ FarmfRaiuch Cleanup Sile <br /> MEDICAL VTASTE PROGRAM(4500) <br /> ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing ❑ Large Generator ❑ Small Generator ❑ Limited Hauler <br /> ❑ Transfer Station ❑ Vclerinary Clinic ❑ Common Storage Facility---❑ 2- 10---❑ 11 -60--- ❑ 6.0 gencrators <br /> PUBLICYIATER SYSTEM PROGRAM(4600) f/seF'11SF.11D /6-02-003 Bluc:IpplicaliorrForm <br /> EMERGENCY 1NOTIRCATiOtt FOR TfUs FACILITY AND1GR PROGRAM <br /> CONTACT PE RSON � _ Day Ph — - Night Ph <br /> I'ROGRnsIFLF1,1F'1,4T '�(741C FEE _ ❑ SurchargQFFF ❑ (tither FEE -- <br /> Ir+srrcToa,x o�tt� 1'i.Rsttl \rnLID _ to CI Food Handler <br /> ❑ Clr:<}.i; lAlc i iV? .4',111) Dale 11NOh:'[i if — <br /> ❑ Cash t'r•.'Ir:`•YI?D 1t 1_1.q aril til tlFrICE Laic - ——•f ��Z _— <br />