Laserfiche WebLink
Ag/Cannery Waste Site <br />Process/Recycle Facility <br />0 Dumpsters >20 cu yd (it or units) <br />Sludge/Ash Site <br />CIA Landfill Site <br />Farm/Ranch Cleanup Site <br /> Capacity Vehicle # <br />0 Chemical Toilets --Number of Units <br />PROGRAM ELEMENT! 0 FEE <br />INSPECTOR # -,J51 f 1 PERMIT VALID <br />Check # AMOUNT PAID <br />EtCash$2,51.12EviEwED BY Li A LA ra C. ACCOUNTING OFFICE <br />Date lq 21 <br />0 Food Handler 4Ar4f$Nr <br />INVOICE # <br />Date <br />I/ <br />Silty -t-Agu PN r "V <br />PA Aa... cuttiVr <br />o itrb <br />NOV 1 5 2021 <br />0 Other FEr-THDISAIM17- <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />MASTERFILE RECORD INFORMATION 6RM <br />New EH Program at Existing Facility New EH Program and New Facility <br />Facility ID r4 00 i ,3'72_.Program Record ID t a205-*/ 352- <br />Facility Address 9-90 S CAA i 611/6. SI Stbajtin C"l Q5 2-03 <br />(Please check the appropriate description and specify size number of units and pertinent information.) <br />FOOD PROGRAM (1600) <br />Restaurant: Seating Capacity Square Footage <br />C0 mmissary 0 Dry storage only 0 with Food Preparation <br />24 <br /> <br />etail Market—Square footage 0 w/Meat Market only <br />Mobile Food Vehicle -Make Vehicle Type <br />Registration # License # <br />Food Handlers Course required: YES 0 No 0 <br />OVending Machines Number of Units <br />0 Multiple Departments 0 Prepackaged Goods Only <br /> Color <br />Sticker # <br />Mobile Food Prep Unit- Make Vehicle Type Color <br />Registration # License # Sticker # <br />Temporary Food Facility -Dates of operation from to 0 Ice Plant 0 Produce Stand <br />Special Event-Dates of operation from to 0 CFO 0 A 0 B <br />DAIRY PROGRAM (2000) <br />Grade A Dairy <br />CUPA <br />0 Grade B Dairy 0 Milk Dispenser-Number of Containers in Multi-Head Unit <br /> <br />Hazardous Materials Business Plan (1900) Number of chemicals: <br />CalARP Program 0 Program 1 Facility 0 Program 2 Facility 0 Program 3 Facility <br />Hazardous Waste Generator (2200) >-Tons Generated Per Year <br />Tiered Permitting Facility > 0 CA (2232) 0 CE (2233, 2234, 2235, 2237) 0 PBR (2231) 0 PBR HHW (2236) <br />Aboveground Storage Tank Facility (AST) (2800) Number of ASTs <br />Underground Storage Tank Program (UST) (2300) Use UST A and B forms <br />Other CUPA Program <br />HOUSING PROGRAM (2400) <br />Hotel/Motel —Number of Units ' 0 Jail or Exempt Institution ----Number of Units <br />Employee Housing (2700) Use Employee Housing/Labor Camp Application Form <br />SITE MITIGATION (2900) UNDERGROUND INJECTION CONTROL (3000) <br />Environmental Assessment 0 UST-CAP Site 0 Local NW Cleanup Site 0 NPUSEP Cleanup Site 0 UIC Site <br />Abandoned HW Site 0 non-NPLJSEP Cleanup Site 0 RWQCB Cleanup Site 0 Water Quality Remediation Site <br />RECREATIONAL HEALTH PROGRAM (3600) <br />Number of Pools/Spas at Facility 0 Pool 0 Spa 0 Out of Service Pool/Spa 0 Natural Bathing Area <br />VECTOR CONTROL PROGRAM (4000) <br />Poultry Farm ----Maximum number of birds <br /> 0 Kennel <br />TATTOO, BODY PIERCING, PERMANENT COSMETIC PROGRAM (4100) <br />Body Art Practitioner Reg (4110) 0 Mechanical DSPS Notification (4115) 0 Body Art Facility-Single Use (4120) <br />Body Art Facility-Sterilization (4121) 0 Body Art Temp Event Co-ord (4130) 0 Body Art-Temp Event Mobile Facility (4131) <br />LIQUID WASTE PROGRAM (4200) <br />Pumper VehicleRegistration # License # <br />Pumper Yard 0 Package Treatment Plant <br />SOLID WASTE PROGRAM (4400) <br />Landfill 0 Transfer Station <br />Waste Tire Facility 0 Compost Facility <br />Refuse Vehicles (# of Units) <br />MEDICAL WASTE PROGRAM (4500) <br />Primary Care 0 Acute Care 0 Skilled Nursing 0 Large Generator 0 Small Generator <br />Transfer Station 0 Veterinary Clinic 0 Common Storage Facility 0 2 - 10 0 11 - 60 <br />PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS El-ID 46-02-003 Blue Application Form <br />EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM <br />CONTACT PERSON rittlittlit -61,211700 otr4c Day Ph 701 - ne-2_399 Night Ph <br />0 Surcharge NE <br />to 31 202-2-/ <br />48-02-034 MASTERFILE RECO D OR ATION PINK <br />1/23/13