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EHD Program Facility Records by Street Name
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GOLDEN POND
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894
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1600 - Food Program
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PR0547456
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Entry Properties
Last modified
2/15/2024 9:47:38 AM
Creation date
2/17/2022 12:41:45 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
BILLING
RECORD_ID
PR0547456
PE
1609
FACILITY_ID
FA0026982
FACILITY_NAME
FERMENT & GRIND
STREET_NUMBER
894
STREET_NAME
GOLDEN POND
STREET_TYPE
DR
City
MANTECA
Zip
95336
CURRENT_STATUS
01
SITE_LOCATION
894 GOLDEN POND DR
P_LOCATION
04
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT PAYtl " <br /> MASTERFILE RECORD INFORMATION FORM RECEdt <br /> ❑ New EH Program at Existing Facility ❑New EH Program and New Facility SAN 2 , <br /> 8 <br /> Facility ID Pro9rM Record ID SJOAQUI <br /> E�/RO NCOUNry <br /> Peaselchecckddress K3k the appropriate description©nd specify size,umber of units and pertinent information.) �H T HOf PAR"NT <br /> FOOD PROGRAM (1600) <br /> ❑ Restaurant: Seating CapacitySquare Footage Food Handlers Course required: YES❑ No ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑Vending Machines Number of Units <br /> ❑ Retail Market—Square footage ❑ w/Meat Market only ❑ Multiple Departments❑ Prepackaged Goods Only <br /> ❑.Mobile Food Vehicle—Make Vehicle Type Color <br /> Registration# License# Sticker# <br /> ❑ Mobile Food Prep Unit--Make Vehicle Type Color <br /> Registration# License# Sticker# <br /> ❑ Temporary Food Facility—Dates of operation from to ❑ Ice Pan ❑ Produce Stand <br /> ❑ Special Event---Dates of operation from to ❑ CFO ❑ A B <br /> DAIRY PROGRAM (2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser-Number of Containers in Multi-Head Unit _ <br /> CUPA <br /> ❑ Hazardous Materials Business Plan (1900) Number of chemicals: <br /> ❑ CaIARP Program ❑ Program 1 Facility ❑ Program 2 Facility ❑ Program 3 Facility <br /> ❑ Hazardous Waste Generator(2200)--->-Tons Generated Per Year <br /> ❑ Tiered Permitting Facility----> ❑ CA(2232) ❑ CE(2233, 2234, 2235,2237) ❑ PBR(2231) ❑ 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 ❑ Jail or Exempt Institution---Number of Units <br /> Employee Housing(2700)Use Employee Housinq/Labor Camp Application Form <br /> SITE MITIGATION(2900) UNDERGROUND INJECTION CONTROL(3000) <br /> ❑ Environmental Assessment ❑ UST-CAP Site ❑ Local HW Cleanup Site ❑ NPL/SEP Cleanup Site ❑ UIC Site <br /> ❑ Abandoned HW Site ❑ non-NPL/SEP Cleanup Site ❑ RWQCB Cleanup Site ❑ Water Quality Remediation Site <br /> RECREATIONAL HEALTH PROGRAM (3600) <br /> Number of Pools/Spas at Facility _ ❑ Pool ❑ Spa ❑ Out of Service Pool/Spa ❑ Natural Bathing Area <br /> VECTOR CONTROL PROGRAM(4000) <br /> ❑ Poultry Farm---Maximum number of birds ❑ Kennel <br /> TATTOO BODY PIERCING,PERMANENT COSMETIC PROGRAM (4100) <br /> ❑ Body Art Practitioner Reg (4110) ❑ Mechanical DSPS Notification (4115) ❑ Body Art Facility-Single Use(4120) <br /> ❑ Body Art Facility-Sterilization(4121) ❑ Body Art Temp Event Co-ord(4130) ❑ Body Art-Temp Event Mobile Facility(4131) <br /> LIQUID WASTE PROGRAM(4200) <br /> ❑ Pumper Vehicle Registration# License# Capacity Vehicle# <br /> ❑ Pumper Yard ❑ Package Treatment Plant ❑ Chemical Toilets--Number of Units <br /> SOLID WASTE PROGRAM(4400) <br /> ❑ Landfill ❑ Transfer Station ❑ Ag/Cannery Waste Site ❑ Sludge/Ash Site <br /> ❑Waste Tire Facility ❑ Compost Facility ❑ Process/Recycle Facility ❑ CIA Landfill Site <br /> ❑'Refuse Vehicles(#of Units) ❑ Dumpsters>20 cu yd (#of units) ❑ Farm/Ranch Cleanup Site <br /> MEDICAL WASTE PROGRAM(4500) <br /> ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing ❑ Large Generator ❑ Small Generator ❑ Limited Hauler <br /> ❑ Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility ❑ 2-10 ❑ 11 -60 ❑ >60 generators <br /> PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Application Fops <br /> W) NOTIF CATION FOR THIS FACILITY ND/OR PR GRAM <br /> CONTACT PERSON r�� Day Ph Ight Ph <br /> PROGRAM ELEMENT (0 Oct FEE (� ❑ Surcharge FEE Other FEE <br /> INSPECTOR# PERMIT VA � t0 El Food Handler <br /> ❑,Check AMOUNT IP to. 0-7) Date INVOICE# <br /> ❑ Cash REVIEWED BY ACCOUNTING OFFICE Date <br /> 48-02-034 .I MASTERFILE RECORD INFORMATION PINK <br /> 1/23/13 // Fx7-r 76b <br />
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