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SAN JOAQUIN COUNTY E"NVIRO1`dPNIENTAL HEALTH DEPAR 'NTEI NU <br /> MASTERFILE RECORD INFORMATION FOR)11 — <br /> ❑ New EH I'rogroni at Fxistiug Facility _ lew Eli Prog niandd N'cw Facility_ <br /> �—Facilily IU —_� ® br _ I'ri orani I cord .71=� _� <br /> Facility Address � 5 <br /> (Please Check-the appropriate description and specify size,nuntl er of uni(s and pertinent rnforma(ion.) <br /> 1-00D PROGRAP,9(1600) <br /> El Restaurant: Seating Opacity Square Footage Food Handlers Course required: YES El No ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ Mth Food Preparation ❑\`ending IMacbiocs—11umber of Units <br /> ❑ Rc(ail Market—Square footage ❑ with heat Market only ❑ Multiple Departments ❑ Prepackaged Goods Only <br /> ❑ )Mobile Food Vehicle---Ariake Vehicle Type Color <br /> Registration# License N Sticker It <br /> ❑ Mobile Food Prep Uni(—Make Vehicle Type Color <br /> Registration# License# Sticker 4 <br /> ❑ Temporary Food Facility--Dates of operation from to ❑ Ice Plant <br /> ❑ Special Eveat --Dates of operation from to ❑ Produce Stand <br /> DAIRY PROGRAM(2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser--llumbcr of Containers in Multi-head Unit <br /> CUPA ❑ State Facility Surcharge(2.399) <br /> HAZARDOUS WASTE PROGRAM(2200) [ <br /> ❑ hazardous Waste Generator-- Toru Generated Per Year ❑ Recycle!Eienrpl System(2299) <br /> ❑ CRT Offsite Handlers (221 e) ❑ Silver Only(2222) ❑ Appliance Recyclers(2217) <br /> Tiered Permitting Facilily —❑ C1011ditionally Authorized (CA) ❑ Coad ihonally Exempt(CE) <br /> ❑ Permit-By-Rule Fixed Unit ❑ Permit-B),-Rule Household Hazardous Waste <br /> ❑ ABOVEGROUND STORAGE T ANIi FACILITY(AST)(2390) llumbcr of AST <br /> UPIDERGROUND STORAGE TANK(UST)PROGRAM(2300)Else UST A and B forms <br /> HOUSING PROGRAM(2400) <br /> ❑ llotelhito(el Number of Units ❑ .Jail or Exempt Insti(ution--Number of Units <br /> Employee Ifousing(2700) Use Etfrplovee Ifuasin&Labor Camp Applicaeiurn Form <br /> SITE MITIGATION(2900) UNDERGROUND INJECTIO[d CONTROL(3000) <br /> ❑ EnAroomeatal Assessment ❑ UST-CAP Site ❑ Local IRV Cleanup Site- Eli,irLISEI'Cleanup Site ElUIC Site <br /> ElAbandoned IM'Site El non-NPL/SEI'Cleanup Site ❑RVN'QCB Cleanup Site ❑ Yater Duality Remediation Site <br /> RECREATIO14AL HEALTH PROGRAM(3000) <br /> Number of Fools/Spa;at Facility ❑ fool ❑ Spa ❑ Ou(of Sri-Ace Pool/Spa ❑ Natural Bathing Area <br /> VECTOR CONTROL PROGRAM(4000) <br /> ❑ Poultry Farm Maximum number of birds ❑ Kennel <br /> TATTOO 13ODY PIERCHIG,PERMANENT COSMETIC PROGRAM(4100) <br /> ❑ Tattooing(412 1) ❑ 13ody Piercing(4120) ❑ I'erruaucnt Cosmetics(4122) <br /> LIQUID WASTE PROGRAM(4200) <br /> ❑ Pumper Vehicle—Registration# License ff Capacity Vehicle# <br /> ❑ Pumper Yard ❑ Package Treatment I'Iant. ❑ Chemical Toilets ldumber of Units <br /> SOLID ViASTE PROGRAM(4400) <br /> ❑ Landfill ❑ Trausfer Station ❑ Ag I Cannery Waste Site ❑ Sludge/Ash Site <br /> bt Waste Tire Facility ❑ Compost Facility ❑ Process(Recycle Facility ❑ CIA,Land(ill Site <br /> ❑ Refuse i'elrides—1lumbcr of Units ❑ Dumpsters>20 to yd —Number of Units ❑ FarndlZanch Cleanup Site <br /> MEDICAL WASTE PROGRAM(4500) <br /> ❑ Primary Circ n .Acute Care D S!filled Nursing ❑ Large Generator ❑ Snra!I Generator ❑ Limited Hauler <br /> ❑ Transfer Siation ❑ Veterina.r)'Cliuic ❑ Copinion Storage F^cili(y-----❑ 2- 10----n 11 -60----❑ >60 gcm ra(urs <br /> PUBLIC VIA i ER S`i"S 7EN1 PROGRAt,1(-!GO)) Ilse,"H'S.FHD 9rt-02-003 Rlrrc Applicarion Furnr <br /> Fa r.11 C-FGrrrc'e l!O'i rrrCr�i 10:1 t on rttrs F AC[Lt n'f .�tto(OR o SZOOP1,AM <br /> +,Ot1TACl'I'FI:S'ON r�\\ Day P!, Nit,h[P!r <br /> t'320C;2•At•[Et.l:ntr•_r:T LAI 140 — ^ _ _ ❑ SurchargeFEE 0ilrcr31E:F, <br /> tvsrecrarr# e 1 i'['[Pall \':11_ID !fir ❑ l'oudHandler----- <br /> ❑ �I:.[.i. �lpirir lr t';., > 1? • lli"r�[ I !I +�-- <br /> f—Ir-, I r - ,enc.;• k7�-- -�I��INll�L—'` ,rn:rr �r_�rrr'C __— =_t'�( _ /�IP�Ld_ 3_---- <br />