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SAN JOAQUIN COUNTY I:NVIROMI-EI`NAL HEALTH DEP R` IA ENT <br /> MASTERFILE RECORD INFOR1 IATION FOIA <br /> ❑1Jety El Program at Existing Facility cvr EI1 Program and New I'acili(y_ <br /> Frac il-it 11 ID F:A CP-�Pb:S��J— I'ro�ram Record ID <br /> Facility Address a!S6G'"1 &-meet CA '?5k'l <br /> (Please Check the appropriate description and specify sue,number of units and pertinent information.) <br /> FOOD PROGRAM(1600) <br /> ❑Restaurant: Seating Capacity Square Footage Food Handlers Course required: YES❑ No ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑Vending 111achiacs—Number of Units <br /> ❑ Retail Market—Square footage ❑with Meat Market only ❑ Multiple Departments ❑ Prepackaged Goods Only <br /> ❑ Mobile Food Vehiclee---h{ake Vehicle Type Color <br /> Registration# License# Sticker# <br /> ❑Mobile Food Prep unit—Make Vehicle Type Color <br /> Registration# License# Sticker# <br /> ❑ Temporary Food Facility--Dates of operation from to ❑ Ice I'laat <br /> ❑ Special Event —Dates of operation from to ❑ Produce Stand <br /> DAIRY PROGRAM(2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ hulk Dispenser--Numbcr of Containers in Multi-Ilead Unit <br /> CUPA ❑ State Facility Surcharge(2399) <br /> IIAZARDOUS WASTE PROGRAM(2200) t <br /> ❑ IIazardous Waste t,cnerator-- Tons Generated Per Year ❑ Recycle I ET—enipl System(2299) <br /> ❑ CRT Offsite I3andlers (2219) ❑ Silver Only(2222) _ ❑ Appliance Recyclers(2217) <br /> Tiered Pern;iitting Facility-- ❑ Conditionally Authorized(CA) ❑ Conditionally Exempt(CE) <br /> ❑Permit-By-Rule Fixed Unit ❑ Pernut-By-Rule Household Hazardous Waste <br /> ❑ABOVEGROUND STORAGE TANK FACILITY(AST)(2390) Numbcr of AST <br /> UNDERGROUND STORAGE TANK(UST)rROGRAM(2300)Use UST A and B rarrrs <br /> HOUSING PROGRAM(2400) <br /> ❑ notenlotel Number of Units ❑ Jail or Exempt Institution--Number of units <br /> Employee housing(2700)Use Iinrplo yee,ffousiti&Lgbor Canrp APpficafiorr Four <br /> SITE MITIGATION(2900) UNDERGROUND INJECTION CONTROL(3000) <br /> [IEnArontneatal Assessment El UST-CAP Site El Local MV Cleanup Site ❑ NP�EP Cleanup Site ❑UIC site <br /> ❑ Abandoned 11W Site ❑ non-NPLISEP Cleanup Site ❑R.WQCB Cleanup Site ❑ NVater Quality Remediation Site <br /> RECREATIONAL HEALTH PROGRAfn(3600) <br /> Number of Pools/Spas at Facility ❑ fool ❑ Spa ❑ Out of Sen-ice h ooUSpa ❑ Natural Bathing Acca <br /> VECTOR CONTROL PROGRAM(4000) <br /> ❑I'oultn'farm Maximum number of birds ❑ Kenael <br /> TATTOO BODY PIERCING PERMAIIENT COSMETIC PROGRAM(4100) <br /> ❑ Tattooing(4121) ❑ Body Piercing(4120) ❑ reruaneat Cosmetics(4122) <br /> LIQUID WASTE PROGRAl,1(4200) <br /> ❑ Pumper Vehicle—Registration# License# Capacity Vehicle# <br /> ❑ Pumper Yard ❑ Pacl�age Treatment Plant ❑ Chemical Toilets Number of Units <br /> SOLID WASTE PROGRAPA(4400) <br /> ❑ Landfill ❑ Transfer Station ❑ Ag/Cannery Waste Site ❑ Sludge/Ash Site <br /> Waste Tire Facility El Compost Facility El 1'rocess(Recycle Facility El CIA Landfill Site <br /> ❑ Refuse Vehicles—Numbcr of Units — ❑ Dumpstcrs>20 cuyd —1lumber of Units ❑ I'.arnt/Ranch Cleanup Site <br /> MEDICAL WASTE PROGRAM(4500) <br /> ❑ Primary C2re ❑ Acute Care ❑ Skilled Nursing ❑ barge Generator ❑ Small Generator ❑ Limited Hauler <br /> ❑ Transfer Station ❑Veterinary Clinic ❑ Common Storage Facility---E] 2- 10---❑ I 1 -60 ----❑ >60 generators <br /> PUBLIC WATER SYSTEM PROGRANI(4600) Use 1 il;SlF111) 16-02-003 LIrrc.41-7plicariou Furor <br /> ENIERGENCY i"IOTIRCITIOH(FOR THIS FACILITY ANDIOR PROGRAM <br /> CONTACT rERSON Day Ph Night Ph <br /> I'ROGIIANI ELFNtENT Ll`Ttip FEL _ �--_❑ Surcharge rE:r L ❑ Other FEE <br /> INsrrc Tor?. ,�� T't'[:t ltt VnttD to_ ❑ Food handler <br /> ❑ rlrcct,rt _b11IOt1iIT e',1IU _ -- llaG'—_-- IirV01i'I�Ii _— — <br /> ❑ Ca,h I'e"te•,;eun; 1:--t-UITI1,-;0rFIC F ----- <br />