Laserfiche WebLink
0 New EH Pro ram at Existing Facilit <br />Facility ID <br />I2New EH Program and New Facility <br />Program Record ID fg. / <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />MASTERFILE RECORD INFORMATION FORM <br />Facility Address 7277 Diamond Ave, Tracy, CA, 95377 <br />(Please check the appropriate description and specify size, number of units and pertinent information.) <br />FOOD PROGRAM (1600) <br />CI Restaurant: Seating Capacity Square Footage Food Handlers Course required: YES CI No CI <br />I=1 Commissary 0 Dry storage only 0 with Food Preparation :Wending Machines Number of Units <br />CI Retail Market----Square footage El w/Meat Market only CI Multiple Departments 0 Prepackaged Goods Only <br />CI Mobile Food Vehicle --Make Vehicle Type Color <br />Registration # License # Sticker # <br />CI Mobile Food Prep Unit-- Make Vehicle Type Color <br />Registration # License # Sticker # <br />0 Temporary Food Facility --Dates of operation from to 0 Ice Plant CI Produce Stand <br />CI Special Event---Dates of operation from to 12 CFO 12 A CI B <br />DAIRY PROGRAM (2000) <br />CI Grade A Dairy CI Grade B Dairy <br />CUPA <br />CI Hazardous Materials Business Plan (1900) Number of chemicals: <br />El CalARP Program 0 Program 1 Facility 0 Program 2 Facility 0 Program 3 Facility <br />Hazardous Waste Generator (2200) > -Tons Generated Per Year <br />CI Tiered Permitting Facility > 0 CA (2232) 0 CE (2233, 2234, 2235, 2237) CI PBR (2231) CI <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 0 Jail or Exempt Institution -- <br />Employee Housing (2700) Use Employee Housing/Labor Camp Application Form <br />SITE MITIGATION (2900) UNDERGROUND INJECTION CONTROL (3000) <br />Environmental Assessment CI UST-CAP Site CI Local HW Cleanup Site CI NPL/SEP Cleanu <br />Abandoned HW Site 0 non-NPLJSEP Cleanup Site 0 RWQCB Cleanup Site 0 Water ality Rem <br />RECREATIONAL HEALTH PROGRAM (3600) <br />Number of Pools/Spas at Facility CI Pool CI Spa 0 Out of Service Pool/Sp CI Natural Bathing Area <br />VECTOR CONTROL PROGRAM (4000) <br />Poultry Farm Maximum number of birds <br />TATTOO, BODY PIERCING, PERMANENT COSMETIC PROGRAM (4100) <br />Body Art Practitioner Reg (4110) CI Mechanical DSPS Notification (4115) <br />Body Art Facility-Sterilization (4121) 0 Body Art Temp Event Co-ord (4130) <br />LIQUID WASTE PROGRAM (4200) <br />Pumper Vehicle Registration # License # <br />CI Pumper Yard CI Package Treatment Plant <br />SOLID WASTE PROGRAM (4400) <br />Landfill 0 Transfer Station <br />CI Waste Tire Facility CI Compost Facility <br />El Refuse Vehicles (It of Units) <br />MEDICAL WASTE PROGRAM (4500) <br />Primary Care 0 Acute Care CI Skilled <br />CI Transfer Station 0 Veterinary Clinic <br />CI Milk Dispenser-Number of Containers in Multi-Head Unit <br />ite <br />ion Site <br />CI Kennel <br />Body Art Facility-SinglAWAV <br />Body Art-Temp Event "bmillg131) <br />CI Chemical Toilets ----Number of Units VA* t 0 2024 <br /> Capacity <br />El Ag/Cannery Waste Site <br />Cl Process/Recycle Facility <br />CI Dumpsters > 20 cu yd (# of Units) <br /> <br />El <br />CIA an <br />SAN JOAQUIN COUNTY <br />0 a <br />SPINglifelTAL <br />POtTMENT <br />CI Farm/Ranch Cleanup Site <br /> <br />Nursing CI Large Generator 0 Small Generator CI Limited Hauler <br />0 Common Storage Facility 0 2- 10 0 11 -60 CI >60 generators <br />PUBLIC WATER SYSTEM PROGRAM (4600) Use PWS EHD 46-02-003 Blue Application Form <br />EMERGENCY NOTIFICATION FOR THIS FACILITY AND/OR PROGRAM <br />CONTACT PERSON Priti Waghode Day Ph 8482344772 Night Ph <br />CI Surcharge FEE PROGRAM ELEMENT kk()0 Y.-D FEE <br />INSPECTOR # V-- 1---' PERMIT VALID • 2.\• 2L1 <br />CI Check # V AMOUNT PAID 1 g7,0 --- <br />CI Cash REVIEWED BY <br />to- <br />Date <br />corN-C-11- 54v/2oa <br />El 0 Other FEE <br />CI Food Handler <br />INVOICE # Z <br />Date ACCOUNTING OFFICE 2/S1 <br />MASTERFILE RECORD INFOR ATION PINK 48-02-034 <br />1/23/13