COMPLIANCE INFO_JEREMY IRVIN - Laserfiche WebLink

Home Browse Search

4 0 • JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT RECORD RM cH Proaram at Existing Facility ❑New EH Program and New Facility ,y 1D C,1z51 I `1 Pro; Ality Address. Sf ,ase check the appropriate description and specify size, , JOD PROGRAM (1600) Restaurant: Seating Capacity Square Footage ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑ Retail Market ----Square footage D with Meat Market only ❑ Mobile Food Vehicle --Make Vehicle Type _ Registration # License # ❑ Mobile Food Prep Unit Make Registration # ❑ Temporary Food Facility --Dates of operation from _ ❑ Special Event Dates of operation from DAIRY PROGRAM (2000) iff Grade A Dairy ❑ Grade B Dairy and pertinent information.) License # IM Food Handlers Course required: YES D No ❑ Mending Machines Number of Units D Multiple Departments❑ Prepackaged Goods Only to _ Color Sticker # Vehicle Type _ Sticker # Color _ ❑ Ice Plant ❑ Produce Stand ❑ Milk Dispenser -Number of Containers in Multi -Head Unit _ CUPA ❑ State Facility Surcharge (2399) HAZARDOUS WASTE PROGRAM (2200) ❑ Hazardous Waste Generator ------------Tons Generated Per Year ❑ Recycle/Exempt System (2299) ❑ CRT Offsite Handlers (2218) -----------❑ Silver Only (2222) ❑ Appliance Recyclers (2217) Tiered Permitting Facility ------- ❑ Conditionally Authorized (CA) ❑ Conditionally Exempt (CE) ❑ Permit -By -Rule Fixed Unit ❑ Permit -By -Rule Household Hazardous Waste ❑ ABOVEGROUND STORAGE TANK FACILITY (AST) (2390) Number of AST UNDERGROUND STORAGE TANK (UST) PROGRAM (2300) Use UST A and B forms HOUSING PROGRAM (2400) ❑ Hotel/Motel -----Number of Units ❑ Jail or Exempt Institution ----Number of Units Employee Housing (2700) Use Employee Housing/Labor Camp 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-NPUSEP 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 _ TATTOO BODY PIERCING PERMANENT COSMETIC PROGRAM (4100) q Tattooing (4121)®6g16,5a J (WBody Piercing Permanent Cosmetics (4122)M&1$1" 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 ❑ Sludge/Ash Site ❑ Waste Tire Facility ❑ Compost Facility ❑ Process/Recycle Facility ❑ CIA Landfill Site ❑ Refuse Vehicles t# of units) D Dumpsters > 20 cu yd (# of units) ❑ Farm/Ranch Cleanup Site MEDICAL WASTE PROGRAM (4500) ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing ❑ Large Generator ❑ Small Generator ❑ Limited Hauler ❑ Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility 112 - 10 011-60 ❑ > 60 generators PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Application Form EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM rnntTerT aF:RcnN Dav Ph Night Ph ❑ Spa ❑ Out of Service Pool/Spa ❑ Natural Bathing Area ❑ Kennel PROGRAM ELEMENT FEE ❑ Surcharge FEE ❑ Other FEE INSPECTOR # PERMIT VALID t0 ❑ Food Handler ❑ Check # AMOUNT PAID Date INVOICE # ❑ Cash REVIEWED BY ACCOUNTING OFFICE Date 48-02-034 MASTERFILE(LJ Y 48-0207