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EnvironmentalHealth
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EHD Program Facility Records by Street Name
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TRACY
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30773
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1600 - Food Program
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PR0548258
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Entry Properties
Last modified
3/7/2024 2:39:27 PM
Creation date
4/10/2023 3:09:09 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
1600 - Food Program
File Section
BILLING
RECORD_ID
PR0548258
PE
1609
FACILITY_ID
FA0027539
FACILITY_NAME
RED BARN RANCH FOODS
STREET_NUMBER
30773
Direction
S
STREET_NAME
TRACY
STREET_TYPE
BLVD
City
TRACY
Zip
95377
CURRENT_STATUS
01
SITE_LOCATION
30773 S TRACY BLVD
P_LOCATION
03
QC Status
Approved
Scanner
SJGOV\ymoreno
Tags
EHD - Public
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SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br /> MASTERFILE RECORD INFORMATION FORM <br /> ❑ New EH Program at Existing Facility ❑New EH Pro ram anQ NewFacility <br /> Facility ID j Program Record ID �U <br /> Facility Address ?L, 77 3 5� i� (J,J -rfi,c y CJ cI537 7 <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 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 Plant❑ Produce Stand <br /> ❑ Special Event---Dates of operation from to CFO ❑ A I�,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 /> ❑ 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 EmploVee 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-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) e <br /> El Landfill El Transfer Station 11Ag/Cannery Waste Site ❑ Sludge/Ash Si cf <br /> ElWaste Tire Facility ❑ Compost Facility ElProcess/Recycle Facility 11 CIA Landfill Si �c MFiy'` <br /> ❑ Refuse Vehicles(#of Units) ❑ Dumpsters>20 cu yd(#of Units) ❑ Farm/Ranch Cleanu �O <br /> MEDICAL WASTE PROGRAM(4500) -144 <br /> ❑ Primary Care El Acute Care El Skilled Nursing ❑ Large Generator ❑ Small Generator ❑ 6S jted Haul Zo23 <br /> ❑ Transfer Station ❑ Veterinary Clinic El Common Storage Facility [12- 10 ❑ 11 -60 `�> d S <br /> PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Application Form ��TN p Nti1l�l�TUNry <br /> EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM _ �p�RTiy HT <br /> CONTACT PERSON c.✓ Jam-- Day Ph AJC; -%�1 Night Ph <br /> PROGRAM ELEMENT FEE ❑ Surrch" r e FE El Other FEE <br /> INSPECTOR# S PERMIT VALID �� to OZ/ � 11 Food Handler <br /> C1 Check# AMOUNT PAID :W Date INVOICE# <br /> E sh REVIEWED BY ACCOUNTING OFFICE Date ?13 <br /> 48 2-0 4 (�*�- <br /> I �(7MASTERFILE CORD INFORMATION PINK <br /> /I1/23/13 /6'U15 <br /> �L l b <br />
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