BILLING/PERMITS - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT MASTERFILE RECORD`INFORMATION FOR11l Mew EH Program at Existin Facility ❑New EH Program and New Facility FacilityID _ fib a< ,H'`Pro ramRecordl_; Facility Address W� r �' 55"7�! (Please Check the appropriate description and specify Ejje,number of units and pertinent information.) FOOD PROGRAM(1600) [:1 Restaurant: Seating Capacity Square Footage Food Handlers Course required:.. YES 11 No❑ ❑ Commissary ❑Dry storage only ❑with Food Preparation ❑Fending Machines—Number of Units ❑ Retail Market—Square footage ❑with Meat Market only ❑ Multiple Departments ❑ Prepackaged Goods Only ❑ Mobile Food Vehicle-----Make Vehicle Type Color Registration# License# Sticker# ❑ Mobile Food Prep Unit—Make VeliicleType Color Registration# License# Sticker# ❑ Temporary Food Facility- Dates of operation from to ❑ Ice Plant ❑ Special Event —Dates of operation from to ❑Produce Stand DAIRY PROGRAM(2000) ❑Grade A Dairy ❑ Grade B Dairy ❑Milk Dispenser---Number of Containers in Multi-Head Unit CUPA ❑ State Facility Surcharge(2399) IIAZARDOUS WASTE PROGRAM(2200) l ❑ Hazardous Waste Generator. Tons Generated Per Year ❑Recycle f Exempt System(2299) ❑ CRT Offsite Handlers(2218) ❑ Silver Only(2222) ❑Appliance Recyclers(2217) Tiered Permitting Facility ❑ Conditionally Authorized(CA) ❑Conditionally Exempt(CE) ❑Permit-By-Rule Fixed Unit ❑Permit-By-Rule Household Hazardous Waste ❑ABOVEGROUND STORAGE TANK FACILITY(AST)(2390) Number of AST UNDERGROUND STORAGE TANK(UST)PROGRAM(2300)Use UST A and B forms HOUSING PROGRAM(2400) ❑ Hotel/Motel Number of Units ❑Jail or Exempt Institution Number of Units Employee Housing(2700)Use Employee HousinzlLabor Camp Application Form SITE MITIGATION(2900) UNDERGROUND INJECTION CONTROL 000) ❑Environmental Assessment ❑UST-CAP Site ❑Local HW Cleanup Site. ❑NPLtSEP Cleanup Site ❑UIC Site ❑Abandoned HW Site ❑non-NPLJSEP Cleanup Site ❑RWQCB Cleanup Site -❑Nater Quality Remediation Site RECREATIONAL HEALTH PROGRAM(3600) Number of Pools/Spas at Facility. ❑Pool ❑ Spa ❑Out of Service Pool/Spa ❑Natural Bathing Area VECTOR CONTROL PROGRAM(4000) ❑ Poultry Farm Maximum number of birds ❑Kennel T'gloo,13ODY PIERCING PERMANENT COSMETIC PROGRAM(4100) Id Tattooing(4121) ❑Body Piercing(4 120) ❑Permanent Cosmetics(4122) LIQUID WASTE PROGRAM(4200) ❑ Pumper Vehicle—Registration# License# Capacity Vehicle# ❑Pumper Yard ❑Package Treatment Plant• ❑Chemical Toilets Number of Units SOLID WASTE PROGRAM(4400) ❑Landfill ❑Transfer Station ❑Ag I Cannery Waste Site ❑ Sludge/Ash Site ❑'Waste Tire Facility ❑ Compost Facility ❑ProcesslRecycie Facility ❑CIA Landfill Site ❑Refuse Vehicles Number of Units ❑Dumpsters>20 cu yd Number of Units ❑Farm/Ranch Cleanup Site MEDICAL WASTE PROGRAM(4$00) ❑ Primary Care ❑Acute Care ❑ Skilled Nursing ❑Large Generator Q Small Generator ❑Limited Hauler ❑Transfer Station ❑Veterinary Clinic ❑ Common Storage Facility—[] 2-10 ❑ 11-60--❑>60 generators PUBLIC WATER SYSTEM PROGRAM(4600)UsePWSEKD 46-02-003 Blue App ication Form EMERGEN Y NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM CONTACT PERSON Day Ph , Night Ph i PROGRAMELEME>,'T_qjLQ FEE ❑Surcharge FEE ❑ Other FEE INSPECTOR# t,J&7,L PERMIT VALID . to ❑ Food Handler ❑ Check# AMOUNT PAID _ Date INVOICE# ❑ Cash REVIEWED BY ' 1, ACCOUNTING OFFICE Date ,k ,, Masterfle'Record Pink