BILLING_2019 - Laserfiche WebLink

Home Browse Search

CI Other FEE l) 61) FEE PERMIT VAL AMOUNT PA rtia ACCOUNTING OFFICE 0 Surcharge FEE to 0 Food Handler Date INVOICE #21 /4-CZ 3 Date 2, /7" MASTERFILE RECORD IN RMATION PINK PROGRAM ELEMENT INSPECTOR # 73 -2_ CI Check CI Cash REVIEWED BY 48-02-034 PAyivi REC ENT EIVED SEp _., ;..,- Facility Address 2-100 r— .4-171.6"` iKli -1,. v•JArq c3 A 015c, t= '_..) SAN JOAQU/N 2 3 2019 E (Please check the appropriate description and specify size, Amber of ants and pertinent information.) tiA1V/Rt.,._ o ECOUIvry ,„.. 1-L, FOOD PROGRAM (1600) ..4%11-• , 1-7 DEpA NTAL Restaurant: Seating Capacity Square Footage Food Handlers Course required: YES CI No tr CI Commissary 0 Dry storage only 0 with Food Preparation :Wending Machines Number of Units Retail Market----Square footage 0 w/Meat Market only CI Multiple Departments 0 Prepackaged Goods Only %Mobile Food Vehicle --Make Vehicle Type Color Registration # Mobile Food Prep Unit-- Make Vehicle Type Color Registration # License # Sticker # CI Temporary Food Facility --Dates of operation from to 0 Ice Plant 0 Produce Stand Special Event---Dates of operation from to 0 CFO 0 A 0 B DAIRY PROGRAM (2000) CI Grade A Dairy 0 Grade B Dairy 0 Milk Dispenser-Number of Containers in Multi-Head Unit CUPA Hazardous Materials Business Plan (1900) Number of chemicals: El CalARP Program 0 Program 1 Facility 0 Program 2 Facility 0 Program 3 Facility Hazardous Waste Generator (2200) >-Tons Generated Per Year El Tiered Permitting Facility > 0 CA (2232) El CE (2233, 2234, 2235, 2237) 0 PBR (2231) 0 PBR HHW (2236) Aboveground Storage Tank Facility (AST) (2800) Number of ASTs CI Underground Storage Tank Program (UST) (2300) Use UST A and B forms CI Other CUPA Program HOUSING PROGRAM (2400) CI Hotel/Motel Number of Units 0 Jail or Exempt Institution ----Number of Units Employee Housing (2700) Use Employee Housing/Labor Camp Application Form SITE MITIGATION (2900) UNDERGROUND INJECTION CONTROL (3000) CI Environmental Assessment 0 UST-CAP Site 0 Local HW Cleanup Site El NPL/SEP Cleanup Site CI UIC Site CI Abandoned HW Site 0 non-NPL/SEP Cleanup Site 0 RWQCB Cleanup Site CI Water Quality Remediation Site RECREATIONAL HEALTH PROGRAM (3600) Number of Pools/Spas at Facility 0 Pool CI Spa CI Out of Service Pool/Spa 0 Natural Bathing Area VECTOR CONTROL PROGRAM (4000) Poultry Farm Maximum number of birds CI Kennel TATTOO, BODY PIERCING, PERMANENT COSMETIC PROGRAM (4100) Body Art Practitioner Reg (4110) El Mechanical DSPS Notification (4115) 0 Body Art Facility-Single Use (4120) Cl Body Art Facility-Sterilization (4121) 0 Body Art Temp Event Co-ord (4130) CI Body Art-Temp Event Mobile Facility (4131) LIQUID WASTE PROGRAM (4200) CI Pumper VehicleRegistration # License #Capacity Vehicle # CI Pumper Yard 0 Package Treatment Plant CI Chemical Toilets ----Number of Units SOLID WASTE PROGRAM (4400) CI Landfill 0 Transfer Station El Ag/Cannery Waste Site CI Sludge/Ash Site CI Waste Tire Facility CI Compost Facility 0 Process/Recycle Facility 0 CIA Landfill Site Refuse Vehicles (# of Units) El Dumpsters > 20 Cu yd (# of Units) CI Farm/Ranch Cleanup Site MEDICAL WASTE PROGRAM (4500) CI Primary Care 0 Acute Care 0 Skilled Nursing 0 Large Generator 0 Small Generator 0 Limited Hauler 0 Transfer Station CI Veterinary Clinic 0 Common Storage Facility 0 2 - 10 0 11 - 60 El > 60 generators PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Application Form EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM CONTACT PERSON \t2 V,Ivld K1 n • • Day Ph s=-(./71 - 14ight Ph /-01 Facility ID r100.266D/ Program Record ID License # -1-;" Oi42 Sticker # SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT MASTERFILE RECORD INFORMATION FORM New EH Program at Existing Facility 0 New EH Program and New Facility 1/23/13