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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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WILSON
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3550
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1600 - Food Program
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PR0547914
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Entry Properties
Last modified
8/25/2023 3:15:39 PM
Creation date
12/6/2022 1:31:25 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
BILLING
RECORD_ID
PR0547914
PE
1684
FACILITY_ID
FA0027317
FACILITY_NAME
GONZALEZ PRODUCE
STREET_NUMBER
3550
Direction
N
STREET_NAME
WILSON
STREET_TYPE
WAY
City
STOCKTON
Zip
95205
CURRENT_STATUS
02
SITE_LOCATION
3550 N WILSON WAY
P_LOCATION
01
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT p`4'YIWEIVr <br /> MASTERFILE RECORD INFORMATION FORM RECEIVE® <br /> ❑ New EH Program at Existing Facility ❑New EH Pro ram and New Facility <br /> Facility ID 06..?-731Program Record ID 5479 AUG 19 ?022 <br /> Facility Address 35"50 I� VJIISDIJ w19V\�j S OISL j SAN JOAQUINCOUNTY <br /> AL <br /> (Please check the appropriate description and specify siENVIRONMEN7 <br /> ze, number of units and pertinent information.) HEALTH DEPARTMENT <br /> FOOD PROGRAM(1600) <br /> ❑ Restaurant: Seating Capacity Square Footage Food Handlers Course required: YES❑ No ❑ <br /> Q 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 Plant❑ Produce Stand <br /> ❑ Special Event--Dates of operation from to ❑ CFO CIAO B <br /> DAIRY PROGRAM (2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser-Number of Containers in Multi-Head Unit <br /> COPA <br /> ❑ Hazardous Materials Business Plan (1900) Number of chemicals: <br /> ❑ CalARP 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 Housing/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-NPLISEP 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 VehicleRegistration# 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 I#of units) ❑ Dumpsters>20 cu yd Mofunits) ❑ 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 Form <br /> MM ERGENCYNOTIFICATION FORTHISFACILITYAND/OR PROGRAM qq���� ''�yy,, <br /> CONTACT PERSON, CAV-41� Q Day Ph ight Ph /(M 403-wWS <br /> PROGRAM ELEMENT ILP9'4 �3 ❑ Surchar•e F E ❑ Other FEE <br /> INSPECTOR# �Z PERMIT VALID g �� Z�Z/-� to 5/3 2 ❑ Food Handler <br /> ❑ Check# AMO NT PAID ,V(J Date INVOICE# 1130 <br /> Cash REVIEWED13Y ACCOUNTING OFFICE Date <br /> 48-02-034 MASTERFILE RECORD INFORMATION PINK <br /> 1123113 <br />
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