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Apr 07 22 02:51 p Century 21 M&M & Assoc. 209-334-2550 p.3 Apt, 0522 02:43p Cent ury21M&M&Assoc, 209-334-2550 SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT MASTERFILE RECORD EI _w EH Prooram and New Facility Address jai \rel-icle Type color 4J5 Reg )sl-atlon A' License $. Sticker# 1.-�1c+ (P lease check the appropriate description and specify size, aumber of units and pertlnent Information.) FOOD PROGRAM (1604) ❑ Restaurant Seating Capacity_ Square Footage ❑ Commissary ❑ Ur/ sto'age only Ll with Food Preparation ❑ Retail MarRot ---- Square footage ❑ vdPAeat Market oily Food Handlers Course required: YE5 ❑ Nu ❑ ❑ Va nding Machines Number of Unite ❑ Multiple Departments 11 Prepackaged Goods Only Ell Mobile Food p.4 &A /11, AFD Jo SAIy OR 0, zzz yEA T N � PARTMENT V ❑ Mobile Food Prep Unit•m Vake Vehicle Type Regi5tiedon # License #S Ll Tempo racy Food Facility—Dates of operation fro.,-_-,__ to ❑ Special Event ---Dates of operation from to C DAIRY PROGRAM (2000) m ker;i _FO f] Ice Plant ❑ Produce stand G❑AB C7 Grade A Dairy ❑ 6rad2 8 hairy ❑Milk Dispenser Uumher cFContamers is El fllulll-Head Uni[ GUPA ❑ Hazardous Materials Business Plan 0900) Numberof chemicals: ❑ CaIARP Program ❑ Program i Facility El Program 2 Facility El Program 3 Facility ❑ Hazardous Waste Generator ("L•L00)-------->-iCns Generated Per Year_ _ ❑ Tiered Permitting Fneility------- > El CA (2232) ❑ CE (2233, 2231, 2235. 2237) El PBR (2231) El PBR HHW (27.3M ❑ Aboveground Storage Tank Facllity (AST) (2BOD) Number of ASTs C] Underground Storage Tank Program (UST) (2300) Use USTA and B F rrns El Other CUPA Program HousiNG PROGRAM (2400) ❑ Hoto)llNotel-----NumW_rof Units CS jail or exempt Institution--Nvmber of Units Employee Housing (2700) USo PrnninVee 14ousinq&abor Cam;)Annf/cation Fo;m SITE MITIGATION (Zg00) UNDERGROUND NjECTION GONTRO:. (3000) ❑ Environmental Assessment ❑ UST•CAP site El Local HW Cleanup Site ElNP41SEP Cleanup Site 11UIC She 17] Abandoned HW Site El non-NPLISEP Cleanup Site ❑ RWQCB Cleanup Site ❑ Water Quality Remediation Site R -CREATIONAL HEALTH PROGRAM (3600) am Isl* pas airs cility _ 7) Pool ❑Spa ❑Out of ServicO Pool/Spa El Natural Bathing Arca VECTOR CONTROL PROGRAId (4000) EI Poultry Farm -•----Maximum rumber of birds 0 Kennel TATTOO nOOY PIERCING M PERANENT COSa1EmC PROGRAM (d100) yet Body Art Practitioner Reg (4110) El Mechanics] DSPS Notification (01 10) 173 Body Art Facility -Single Use (4120) ❑ Body Art Facllity-Sterilization (4121) ❑ Body Art Temp EVCnt Co -Ord (4130) ❑ Body Art -Temp Event Mobile Facility (4131) LIQUID WASTE PROGRAM (4290) ❑ Pumper VellicleRegiMlonlOn If License r( Cepacity Vehicle fl ❑ Pum per Yard El Package Treatment Plant ❑ Chemical Toilets—Numoer of Units_._ 50LID WASTE PROGRAM (4500) 11 Landfill 11 Transfer Station ElAgiCannery Waste Site 11Sludge/Ash Site C3 Waste Tire Facility ❑ CompostFacility LJ Process/Recycle Facility C1 CIA Landfill site D Refuse Vehicles wor unft) ❑ Gumpslers> 20 on yd (a of dais) ❑ FarmlRanch Clea nup Site b1EDICAL WASTE PROGRAM (4500) 11 primary Care © Acute Care El Skilled Nursing ❑. Large Generator I7 Small Generator i7 Limited Hauler ❑ Transfer Station LI Veterinary Clinic El Common Storage Facility C Z-10 ❑1i -do ❑>60 generators PUBLIC WATER SYSTEM PROGRAM (2600) Use PWS F.HO 46.02-002 Stile ApAlicatiort Farm cotaracr ray PROGRAM ELEMENT_, r�,•�.(�_ PEE �.,y5 C1 Surchar c Fee ,-v )rusvEcrnaft PrI$rx IT VAl1P��7'7`%�Z�Z � t0 L chat!) AMOUNT PAID IS ) Date PT 171Cas�l nEvleV"BY Accc�nrir+60rFrcE l� OHteY FEE ❑ Food Har INVOICEr'i Vehicle—Ariake \rel-icle Type color Reg )sl-atlon A' License $. Sticker# ❑ Mobile Food Prep Unit•m Vake Vehicle Type Regi5tiedon # License #S Ll Tempo racy Food Facility—Dates of operation fro.,-_-,__ to ❑ Special Event ---Dates of operation from to C DAIRY PROGRAM (2000) m ker;i _FO f] Ice Plant ❑ Produce stand G❑AB C7 Grade A Dairy ❑ 6rad2 8 hairy ❑Milk Dispenser Uumher cFContamers is El fllulll-Head Uni[ GUPA ❑ Hazardous Materials Business Plan 0900) Numberof chemicals: ❑ CaIARP Program ❑ Program i Facility El Program 2 Facility El Program 3 Facility ❑ Hazardous Waste Generator ("L•L00)-------->-iCns Generated Per Year_ _ ❑ Tiered Permitting Fneility------- > El CA (2232) ❑ CE (2233, 2231, 2235. 2237) El PBR (2231) El PBR HHW (27.3M ❑ Aboveground Storage Tank Facllity (AST) (2BOD) Number of ASTs C] Underground Storage Tank Program (UST) (2300) Use USTA and B F rrns El Other CUPA Program HousiNG PROGRAM (2400) ❑ Hoto)llNotel-----NumW_rof Units CS jail or exempt Institution--Nvmber of Units Employee Housing (2700) USo PrnninVee 14ousinq&abor Cam;)Annf/cation Fo;m SITE MITIGATION (Zg00) UNDERGROUND NjECTION GONTRO:. (3000) ❑ Environmental Assessment ❑ UST•CAP site El Local HW Cleanup Site ElNP41SEP Cleanup Site 11UIC She 17] Abandoned HW Site El non-NPLISEP Cleanup Site ❑ RWQCB Cleanup Site ❑ Water Quality Remediation Site R -CREATIONAL HEALTH PROGRAM (3600) am Isl* pas airs cility _ 7) Pool ❑Spa ❑Out of ServicO Pool/Spa El Natural Bathing Arca VECTOR CONTROL PROGRAId (4000) EI Poultry Farm -•----Maximum rumber of birds 0 Kennel TATTOO nOOY PIERCING M PERANENT COSa1EmC PROGRAM (d100) yet Body Art Practitioner Reg (4110) El Mechanics] DSPS Notification (01 10) 173 Body Art Facility -Single Use (4120) ❑ Body Art Facllity-Sterilization (4121) ❑ Body Art Temp EVCnt Co -Ord (4130) ❑ Body Art -Temp Event Mobile Facility (4131) LIQUID WASTE PROGRAM (4290) ❑ Pumper VellicleRegiMlonlOn If License r( Cepacity Vehicle fl ❑ Pum per Yard El Package Treatment Plant ❑ Chemical Toilets—Numoer of Units_._ 50LID WASTE PROGRAM (4500) 11 Landfill 11 Transfer Station ElAgiCannery Waste Site 11Sludge/Ash Site C3 Waste Tire Facility ❑ CompostFacility LJ Process/Recycle Facility C1 CIA Landfill site D Refuse Vehicles wor unft) ❑ Gumpslers> 20 on yd (a of dais) ❑ FarmlRanch Clea nup Site b1EDICAL WASTE PROGRAM (4500) 11 primary Care © Acute Care El Skilled Nursing ❑. Large Generator I7 Small Generator i7 Limited Hauler ❑ Transfer Station LI Veterinary Clinic El Common Storage Facility C Z-10 ❑1i -do ❑>60 generators PUBLIC WATER SYSTEM PROGRAM (2600) Use PWS F.HO 46.02-002 Stile ApAlicatiort Farm cotaracr ray PROGRAM ELEMENT_, r�,•�.(�_ PEE �.,y5 C1 Surchar c Fee ,-v )rusvEcrnaft PrI$rx IT VAl1P��7'7`%�Z�Z � t0 L chat!) AMOUNT PAID IS ) Date PT 171Cas�l nEvleV"BY Accc�nrir+60rFrcE l� OHteY FEE ❑ Food Har INVOICEr'i