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SAN JOAWUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT I _ MASTERFILE RECORD INFORMATION FORM _ �- ---_ R q YM ❑ New FH Pra;7rari a1 Existin Faeliity 9tJr!v, EH Pro ,an1..�u1 New Facilit C__ ID J � Program Record ID LL L� MAY k6Q Facility Address -a3i n,_ i�� 1rnl 5 � -1'�'1 ►+� T cC-t1 Ll _ 3 K,_ S41V y t liar_.K the ar.-`:?lr wte desrr,ptinn and sperrfy r,Humber of units and pertlrtient�j�(r QLIT�aticn.(�'FgcT�RpNM�COU Fcoo FR:iGF?/�rd (1�afl} P4 74 Restaurant. °::eat ng ^ rr^ly 1 goare Eoclag& _ F"d Handlers Cualrso [e uq Ired- yr:s L'I' dg - ❑ Con)rrlissarl ❑ Ury s?orage wly70 C] 'Nita r°rr)d 1'reraTahan [Wending fl,achinat}Nlulihur of Jnit Rotail hl�lrket----5 uare f Stsa3o ❑ mi Veal Nlar<e1 only G wjit'pie L`•"_pri�lliw-i-1 4 Prepackafled Gucds Only ❑ fenbi_e Fcoc Vehicle-dr:ak=_ Vphiclu Type Color i;f,<;isiration'If I,ia yn n cairker? D fdobile Food Prep Unit,-hr,ik� Vehicle Type. Reg stri3l an ft License A _ Stick&r 9 Temporary Food Facility--Oa!e,;or uperation from _ to ❑ Ice (Plant❑ Produce Stand IJ Special E-rmnt--Dat25 of ef>rration rrui ; _ _ to CFO ❑ .A ❑ I! DA1HY PROGRAM( l2ra01 ❑ Grade At Dalry ❑ Grade B Dairy Milk Dispenser-.'Dumber of Cnntairers in r+i- It-1-lea I Lhii; CUP:+ C3 Hazardous rilaterials Business Platt 11300) Nnrnh+l-o*chemlc.:al3 _ ❑ CalARP Program ❑ Program f Facility I7 Program 2 Facility Program 3 Facility ❑ Harardous Warta GenetatarTons G;related Per'fear ❑ Tle+ed Permitting Farility -------=• ❑ CA1,22;32) ❑ CE 1:223.,2234.2235,2237'1 ❑ PSR (2231) ❑ PE3R HHW,;22331 ❑ Abovegrntrnd S►-oragc Tank Facility{AST) (2800) Nu,rnber of ASTa +�Underground Storage Tank Program ILISTI (2300) Usa J§T A avd B forms Other CUPA Program I1O•J51N(�PROGRAM ;'240Q) ❑ ---Nu nrcer 0 tEl J;iir or Exempt Institution •••.Nurilbcr o=Units €rnrloyeE HL-usi:,g 17.700; Use E_mpfoVee Nnusfnep tabes Cam �a�cai;catigp Fcrrrl SITZ=h11TIGAT,,0N x2900) , rzR,OUMD I'L,_G-p;P: :1rJTijUL(,3170;7'( ❑ Environmental Aasessrment :1 UST-CAP Site ❑ Local HW Cleanup Site ElNPLISE' R Cleanup Sita: 01UIC site ❑ Abandoned Wed Sita 17 non-NPLJSEP Cleanup Sitc ❑ RWQC13 Cieanup Site ❑ Water Quality Remediation Site RECREA r,oNAt,-1E„;.l H MQ(� RA+NI (3003, NL-f`D- rif b'ECI�R Pccd!i.lsp�is at Fa^;lyp El Pool ❑ Spa El Out of Service PooV-Spa C] ksturaI Bathing Arta CO!J+ -Q-L- RGGRAM(4C-301 ❑ Pc•ultty Farm-------'AaArnurn nl.lmbor cf bind, _ L] Kennel TATT120 agq,) ?(RC1NO,PERrhkNENT COSMFTir PROGRAM (41x 1) G toady An Practitioner Reg (411CI) ❑ Mochanical ASPS Notlflca lion (411 C;a Body Art Facility-Single Use(4^.,20) ❑ Body Art Facility-Sterilization (•812 1'1 :D Body Art Temp Evcnt Co-ord 1tl'r,; ❑ Siody Art-Temp Evcrt hlobJle Facility (4131; _lull i[IYL§t P -( F11142r{; ❑ Purnper Vch;clsF egcaral'an rt Licen::r:# Lelracity le car-# ❑ PUrrrpor Yard ❑ Package Treatment Plant +' Cha:rrical Tol!ets of Uilits S-JI In 144')0i -- C Landfill ❑ Tramsfvr Station ❑ AgiCanrrery Waste Site ❑ SludgaiAsh Site ❑ Waste Tire Facility ❑ Compost Facility ❑ ProcessfRecycle FaclJity L1 CIA Landfill Site ❑ RE-fuse- Vehicles ld cr urilsl - _ ❑ Du,nl:it.L rs � 20 cu yd rt'3,u•11a;_ _ ❑ Farm;Ranch Cleanup Site 31rOICAL kV,k.3TE ORO- L1 (4590) J Primary Care ❑ Acute Carr; ❑ Skilled Nursing C, Large, Generator ❑ Small Generator ❑ Limited Hauler Tranxfcr 5tstic�n ❑ Veterinary Clhric common Storage Facility 0 r 1r' El 11 -x50 � � it generakxs PUF�I-I•:.WATER SY F-11 EagCRArA (4Ho7) L'ss pWS FAD 46-D2.003 Ali—-a—f car.'on Fr,rr" EI.IERGENC'r,NUTIFIiA N rQP.THIS FACILITY A.Vfo pROGR�pn CONTACT PERSON �,l¢f ` r� L- rL t.[rr.7 Lra rti ` Jr l f F PROGR.ahi ELUIEW 17_ d ❑ Surch�aj FEE C ) Other FEF — U;5vcr roR g PFRACT V LID � to 7 ❑ Focod Handier ` ❑ (:r'?J. AMOUNT PAID p . 0D D31 # ❑ C•a9 1 R=_ti 1F1+lEU C+'r AcvouNb•WG OFFK E DaW !;i; fi.FA'TLRFL=RTGOHO WMRMADON FINK