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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT MASTERFILE RECORD INFORMATION FORM ® New EH Pro ram at Existin Facili ❑New EH Pro ram and New Facilit Facility ID � pD2.71J � Program Record ID �Rj�ry-%�� Facility Address Colorful Addictions Studios ��I Ip-I-� S� . T�2G(G�,, ('q �� 3}�� (Please check the appropriate description and specify size, number of units and pertinent information.) FOOD PROGRAM (1600) ❑ Restaurant: Seating Capacity Square Footage Food Handlers Course required: Yes ❑ No ❑ ❑ Commissary ❑Dry storage only ❑with Food Preparation ❑Vending Machines Number of Units ❑ Retail Market ----Square footage ❑ w/Meat Market only ❑Multiple Departments ❑Prepackaged Goods Only ❑ Mobile Food Vehicle --Make Vehicle Type Color Registration # License # Sticker # ❑ Mobile Food Prep Unit --Make Vehicle Type Color Registration # License # Sticker # ❑ Temporary Food Facility --Dates of operation from to ❑Ice Planf ❑Produce Stand ❑ Special Event ---Dates of operation from to ❑CFO ❑ A ❑ B DAIRY PROGRAM (2000) ❑ Grade A Dairy ❑ Grade B Dairy ❑Milk Dispenser -Number of Containers in Multi -Head Unit COPA ❑ Hazardous Materials Business Plan (1900) Number of chemicals: ❑ CaIARP Program ❑Program 7 Facility ❑Program 2 Facility ❑Program 3 Facility ❑ Hazardous Waste Generator (2200) ---------->-Tons Generated Per Year ❑ Tiered Permitting Facility -------> ❑ CA (2232) ❑ CE (2233, 2234, 2235, 2237) ❑ ❑ Aboveground Storage Tank Facility (AST) (2800) Number of ASTs ❑ Underground Skorage Tank Program (UST) (2300) Use UST A and 8 forms ❑ Other COPA Program PBR (2231) ❑PBR HHW (2236) HOUSING PROGRAM (2400) ❑ Hotel/Motel ------Number of Units ❑Jail or Exempt Institution ----Number of Units Employee Housing (2700) Use Employee Housing/Labor Cama Application Form SITE MITIGATION (2900) UNDERGROUND INJECTION CONTROL (3000) ❑ Environmental Assessment ❑UST -CAP Site ❑Local HW Cleanup Site ❑ NPL/SEP Cleanup Site ❑ UIC Site ❑ Abandoned HW Site ❑non-NPLISEP Cleanup Site ❑ RWQCB Cleanup Site ❑Water Quality Remediation Site RECREATIONAL HEALTH PROGRAM (3600) Number of Pools/Spas at Facility _ ❑Pool VECTOR CONTROL PROGRAM (4000) ❑ Poultry Farm -------Maximum number of birds ❑Spa ❑ Out of Service Pool/Spa ❑Natural Bathing Area ❑ Kennel TATTOO, BODY PIERCING. PERMANENT COSMETIC PROGRAM (4100) ® Body Art Practitioner Reg (4110) ❑Mechanical DSPS Notification (4115) ❑Body Art Facility -Single Use (4120) ❑ Body Art Facility -Sterilization (4121) ❑Body Art Temp Event Co-ord (4130) ❑Body Art -Temp Event Mobile Facility (4131) 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/Cannery Waste Site ❑ SludgelAsh Site ❑ Waste Tire Facility ❑Compost Facility ❑Process/Recycle Facility ❑ CIA Lp}�a'_n'�dfil'l Site ❑ Refuse Vehicles (u of upas) ❑ Dumpsters > 20 cu yd (# of units) ❑ Farlh�leanup Site MEDICAL WASTE PROGRAM (4500) I� -�,• ,�,ttt'77, ❑ Primary Care ❑Acute Care ❑Skilled Nursing ❑Large Generator ❑Small Generator �I��i[auler ❑ Transfer Station ❑Veterinary Clinic ❑Common Storage Facility ❑ 2 - 10 ❑ 11 - 60�U� Ct > 60 generators PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46.02-003 Blue Aoplication Form .`rAly JO � 202Z Dan WIISODEMERGENCY NOTIFICATION FOR THIS FACTLITYAND/OR PROGRAM y..FN��„��®N CONTACT PERSON Day Ph 2098345322 Night PCChhAA�`// `x'``77 47� PROGRAM ELEMENT�� INSPECTOR # ❑Check # LI C � h REVIEWED 48- 2-034 n M IU{: I� I 1/23!13 t„lLl lQrl" 1`CO j _FEE � � S -- ❑ SI _ PERMIT VALID � � 22 t0 AMOUNT PAID �' Date zl ACCOUNTING OFFICE ❑ Other FEE ❑ Food Handler INVOICE # 3 Date � /�} �