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fkrib z <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />MASTERFILE RECORD INFORMATION FORM 'P RAD <br />Li New EH Program at Existing Facility New EH Program and New Facility Facility ID Program <br />Record ID <br />Facility Address 9143 Blue Fox Way, Stockton, CA, 95209 <br />(Please check the appropriate description and specify size, number of units and pertinent <br />information.) FOOD PROGRAM (1600) <br />Restaurant: Seating Capacity Square Footage Food Handlers Course required: YES v No Li E <br />Commissary E Dry storage only Li with Food Preparation EVending MachinesNumber of Units <br />Market----Square footage 1! ! 171 w/Meat Market only E Multiple Departments 1E Prepackaged Goods Only <br />El Mobile Food Vehicle --Make Vehicle Type Color <br />Registration # License # Sticker # E Mobile Food Prep <br />Unit-- Make Vehicle Type Color Registration # <br /> License # Sticker # <br />Li Temporary Food Facility --Dates of operation from to 7 Ice Plant El Produce Stand El <br />Special Event---Dates of operation from to XCFOXAEB <br />DAIRY PROGRAM (2000) <br />Grade A Dairy 7 Grade B Dairy El Milk Dispenser-Number of Containers in Multi-Head Unit <br />CU PA <br />El Hazardous Materials Business Plan (1900) Number of chemicals: <br />CalARP Program IE Program 1 Facility 7 Program 2 Facility E Program 3 Facility Li Hazardous Waste <br />Generator (2200) >-Tons Generated Per Year <br />El Tiered Permitting Facility > E CA (2232) E CE (2233, 2234, 2235, 2237) [1 PBR (2231) El PBR HHW (2236) Ei <br />Aboveground Storage Tank Facility (AST) (2800) Number of ASTs <br />Li Underground Storage Tank Program (UST) (2300) Use UST A and B forms <br />Li Other CUPA Program <br />HOUSING PROGRAM (2400) <br />Hotel/Motel Number of Units 17 Jail or Exempt Institution ----Number of Units Employee <br />Housing (2700) Use Employee Housing/Labor Camp Application Form <br />SITE MITIGATION (2900) _UNDFRGROUND INJECTION cONTROI (3000) <br />Environmental Assessment E UST-CAP Site 17 Local HW Cleanup Site El NPL/SEP Cleanup Site E UIC Site 171 <br />Abandoned HW Site LI non-NPL/SEP Cleanup Site Li RWQCB Cleanup Site 111 Water Quality Remediation Site <br />RECREATIONAL HEALTH PROGRAM (3600) <br />Number of Pools/Spas at Facility O Pool E Spa E Out of Service Pool/Spa E Natural Bathing Area <br />VECTOR CONTROL PROGRAM (4000) <br />Li Poultry Farm Maximum number of birds E Kennel TATTOO. BODY PIERCING <br />PERMANENT COSMETIC PROGRAM (4100) <br />Body Art Practitioner Reg (4110)17 Mechanical DSPS Notification (4115) E Body Art Facility-Single Use (4120)171 Body Art <br />Facility-Sterilization (4121) 7 Body Art Temp Event Co-ord (4130) EI Body Art-Temp Event Mobile Facility (4131) <br />LIQUID WASTE PROGRAM (4200) <br />El Pumper VehicleRegistration # License # Capacity Vehicle # Li <br />Pumper Yard 7 Package Treatment Plant Li Chemical Toilets ----Number of Units <br />SOLID WASTE PROGRAM (4400) <br />Li Landfill Li Transfer Station E Ag/Cannery Waste Site El Sludge/Ash Site El Waste Tire Facility El Compost Facility 17 <br />Process/Recycle Facility E CIA Landfill Site E Refuse Vehicles (# of Units) Li Dumpsters > 20 cu yd (# of Units) Li <br />Farm/Ranch Cleanup Site <br />MEDICAL WASTE PROGRAM (4500) <br />Ei Primary Care El Acute Care El Skilled Nursing El Large Generator Li Small Generator Li Limited Hauler E Transfer Station <br />El Veterinary Clinic PI Common Storage Facility E 2 - 10 7 11 - 60 7 > 60 generators PUBLIC WATER SYSTEM PROGRAM (4600) <br />Use PWS EHD 46-02-003 Blue Application Form <br />EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM <br />CONTACT PERSON ItZCOati Friaz Day Ph 209-482-5342