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COMPLIANCE INFO
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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N
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99 (STATE ROUTE 99)
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19919
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4400 - Solid Waste Program
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PR0440075
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COMPLIANCE INFO
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Last modified
11/19/2024 1:56:02 PM
Creation date
7/3/2020 11:20:35 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
4400 - Solid Waste Program
File Section
COMPLIANCE INFO
RECORD_ID
PR0440075
PE
4467
FACILITY_ID
FA0000097
FACILITY_NAME
HANK VAN EXEL
STREET_NUMBER
19919
Direction
N
STREET_NAME
STATE ROUTE 99
City
LODI
Zip
95242
CURRENT_STATUS
02
SITE_LOCATION
19919 N HWY 99
P_LOCATION
99
P_DISTRICT
004
QC Status
Approved
Scanner
CField
Supplemental fields
FilePath
\MIGRATIONS\SW\SW_4467_PR0440075_19919 N HWY 99_.tif
Tags
EHD - Public
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F_*ts;6 1 S� , as le-k — dt.,Ilte.--A-- sot__ <br /> GENERAL PROGRAM FILE New Change Edit (PROG3) revised 52193 <br /> FACILITY ID # 000LIP -FACILITY NAME e_ VA-AJ Ile>Cr (__ <br /> RECORD ID # �'� `f�C107� PRI SWEE /COMP <br /> _ DAIRY: Grade A Grade B Milk Dispenser Number of Containers in Mutti-Head Unit <br /> _ FOOD: Restaurant Market Commissary Mobile Food Produce Stand Ic_e Plant <br /> Seating Capacity Sq Ft Market w/Food Prep: Y / N Number of Vending-Machines <br /> Food Vehicle Make License # Registration # Color <br /> HAZARDOUS WASTE: Tons Generated/Yr TIERED PERMIT Facility : CA CE PBR <br /> _ HOUSING: Hotel/Motel No. of Units Jail/Exempt Institution <br /> Employee Housing No. of Employees Approx Dates of Occupancy _/ / to <br /> _ LIQUID WASTE: Pumper Vehicle Pumper Yard Chemical Toilets No. Package Tx Plant <br /> _ MEDICAL WASTE: Primary Care Acute Care Skilled Nursing Lg Generator Sm Generator <br /> Storage (2.10) _ Storage (11-50) _ Storage ( >50 ) _ Transfer Sta _ Ltd Hauler _ Vet Clinic _ <br /> _ RECREATIONAL HEALTH: Poot/Spa Number of Pools Out of Service Pool Natural Bathing Place <br /> _ SITE MITIGATION: Environ Assess UST/CAP Loc Haz Waste Haz Mat PPL <br /> ✓/ Other Lead Agency Site Agency: RWQCB DTSC NPL Site RB/H20 Q Other <br /> _ SOLID WASTE: Landfill Transfer Sta Recycling Fac Waste Storage Fac Ag Waste/Exempt Site <br /> SW Vehicle No. Dunpster No. Stationary Compactor Site <br /> I _ VECTOR CONTROL: Poultry Farm Max Number of Birds Kennel <br /> EMERGENCY NOTIFICATION for this FACILITY and/or PROGRAM DAY NIGHT <br /> CONTACT 1 . ( ) ( ) <br /> CONTACT 2 . <br /> DESIGNATED EMPLOYEE # _ PROGRAM ELEMENT # L�L ��, CURRENT STATUS <br /> # OF UNITS : EPA ID #: INSPECTION CODE <br /> BILLING ACKNOWLEDGEMENT: I, the undersigned owner, operator or agent of same, acknowledge that all site and/or project specific <br /> PHS/EHD hourly charges associated with this facility or activity will be billed to the party identified as the BILLING PARTY on <br /> this form. <br /> I also certify that I have prepared this application and that the work to be performed will be done in accordance with alt SAN <br /> JOAQUIN COUNTY Ordinance Codes and Standards, State and Federal laws. <br /> APPLICANT'S SIGNATURE <br /> Title: Date: <br /> AUTHORIZATION TO RELEASE INFORMATION: In addition to the above, when applicable, I, the owner, operator or agent of same, of <br /> the property Located at the above site address hereby authorize the release of any and all results, geotechnical data and/or <br /> environmental/site assessment information to SAN JOAQUIN COUNTY PUBLIC HEALTH SERVICES ENVIRONMENTAL HEALTH DIVISION as soon as <br /> it is available and at the same time it is provided to me or my representative. <br /> Fee Amount Amount Paid Date of Payment Payment Type Receipt # Check # Recvd By <br /> REHS �rL rGi/ zq , �` SUPV _/_J ACCT / UNIT CLK _/__J <br />
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