BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT RECORD INFORMATION FO S ERFILE•R„ IRM. _ JL fdrx EH Progrim at Existing Facility ❑Nos cH Progr3m ;and New Facility Facility 10 OAOO,a47,1 ` Pro ram Record ID.� -- k Facility Address _46 4_ IPlere:�;;!SecN the rvp{?mph:;te description and sperrfy size, number of units.vv)vrrtinent information.l FOOD PROGRAM 0600) ❑ Restaurant. Seating CAp;:clty Square.Footage _ Food Handlers Course required: Ye; ❑ Nn ❑ ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑Vending Machines Nuriber of Units ❑ Retail Market---.Square Inotage__. __._. ❑ with Meat h48rket only ❑ Multiple Cepartmertis❑ Prepackaged G.uri. :::r,> 7,Mobile Food Vehicle-Mnkc -c- 'N c.--------- �`�hlr•, T,i Re G_ ke ✓=t�•r�_ Color Re,j`SIraUUn=-I6l-0 H_P_-5.21��r3Sv�y Yxc e. 513 VI_/Oy � _ StiCl;a ❑ Mobile Food Prep Unit �rl:wLe -_-_ _ ---etacle Type id ❑ Temporary Food Facility -Gates of operatiun from _ to _ ❑ Ice Plant ❑ Special Event Dales Of operation from_ ,q_ __'--T-- ❑ Produce Stand DAIRY PROGRAM (2000) ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Oispenser-Numhur of Contaelors in Multi-Hnad Un.( CUPA ❑ State Facility Surcharge(2399) HAZARDOUS WASTE PROGRAM(2200) O Hazardous Waste Generator-----------1 un; Generated Fcr YearC] Recycle/Exempt System (22991 ❑ CRT Offsae hiandfer3 ;22,,81 -------------❑ >dvor(lrly t°222) v ❑Aoohance Rery,nfor;(22217; Tiered Permitting Facility -------------------❑ Conru,onilly A.utho, zed rCA) ❑ Conditionally Exempt(CE) ❑ Pr3nrR:;y-RUIo F-xod Unit ❑ P01mit-By-RU10 Housohoid -A_ra.. ❑ ABOVEGROUND STORAGE TANK FACILITY fAST) (2'90) Number of ASt UNDERGROUND STORAGE TANK IUST PROGRAM (2300) Usc UST A and B forms HOUSING PROGRAM 12400) ❑ Hotel/Motel---Number of Units ❑ Jail or Exempt institution ---\rurnber o'Units Employee Housing (27D01 Use Ernpfoyee Nousino/Labor Camp Application_Fam SITE MITIGATION 129001 lifa['16RGUNU I�_,;E t:TIUi1 J;_pNT_fif�L(3D`JO) ❑ Environmental Assessment ❑ UST-CAP Site ❑ Local HW Cleanup Site ❑ NPUSEP Cleanup Site ❑ UIC Site ❑ Abandoned HW Site ❑ non-NPLISEP Cleanup Sitc ❑ RWQCB Cleanup Site ❑ Water Quality Remediation Silo RECREATIONAL HEALTH PROGRAM '1360.0j NUMDe•I Of PoDkfSpas al Facif n',— ❑ Pool ❑ Spa ❑ Out of Service Pool/Spa ❑ Natural Bathing Area VECTOR CONTROL PROGRAM (4000) ❑ Poultry Farm.--_Maximum number of birds ❑ Kennel TATTOO,BODY PIERCING PERMANENT COSMETIC PROGRAM (41110) ❑ Tattooing (4121) ❑ Body Piercing (1120) ❑ Permanent Cosmetics , 1 i"', LIQUID WASTE PROGRAM(4200) ❑ Pumper Vehicle Regisirsbwi a -_-_ _-_ License ti __ __ ❑ Pumper Yard ❑ Package Treatment Plant ❑ Chemical Toilets --Number of Units SOLID WASTE PROGRAM 144001 ----- ❑ Landfill ❑ Transfer Station ❑ Ag:Cannery Waste Site ❑ Sludge/Ash Site ❑ Waste Tire Facility ❑ Compost Facility ❑ Process/Recycfe Facility ❑ CIA Landfill Site Reinse Vehicles is�r,•,)r• _ (.] 11i•.n.1�s•„-,.s> 2C cu yd t.,,l ��;:. ❑ Farmfftanch Cleanup Sive MEDICAL WASTE PROGRAM (45UPj ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing Ci Large Generator ❑ Small Generator ❑ Limited Hauler ❑ Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility ❑ 2 - 10 ❑ 1 i -60 ❑ .- i,9 qen;rat. PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Applicaflon Pe?^u EMEPG[NCY NO(IFICATION FOP,ims FACILITY ANO(OR PROGRAM CONTACT PERSON a.e Day Ph 9_ b 't -_ - 0 Night Pit r PROGRAM ELEMENT�al FEE—a .DI E) strrch,rge EE ❑ Other FEE IgSPL•CTOHN ��p� PER6lif VALID � tp I 3l l/ 1 p2-.7�/� � ❑ EOOd Handler q AMOUNT Date_! _ '�/./' INVu1C.E i”❑` Cash .RFvrv,-n 6Y " -r. . F`"_F `LLt .Date nr.n .n',a '!oRr