Laserfiche WebLink
ColorMake <br />to <br />to <br /> Milk Dispenser-Number of Containers in Multi-Head Unit <br /> Natural Bathing Area Out of Service Pool/Spa Pool Spa <br /> Kennel <br /> Permanent Cosmetics (4122) <br />Fee <br />¥___/ <br />7/WzJ/ / <br />MASTERFILE RECORD INFORMATION PINK48-02-034 <br />11/15/07 <br /> Ag/Cannery Waste Site <br /> Process/Recycie Facility <br /> Dumpsters > 20 cu yd (# of Units) <br /> Recycle/Exempt System (2299) <br /> Appliance Recyclers (2217) <br /> Conditionally Exempt (CE) <br /> Permit-By-Rule Household Hazardous Waste <br />__ Ice Plant <br /> Produce Stand <br /> UIC Site <br /> Water Quality Remediation Site <br /> Sludge/Ash Site <br /> CIA Landfill Site <br /> Farm/Ranch Cleanup Site <br /> Capacity Vehicle# <br /> Chemical Toilets —Number of Units <br /> License # <br /> Package Treatment Plant <br /> Surcharge Fee <br />to F—~7 ~ ( <br />Amount Paid Date <br />Reviewed by ^7 Accounting Office <br />Day Ph 214-563-0763 Night Ph <br /> Other FEE <br /> Food Handler <br />Invoice# <br />Date <br />___ License # <br />Square Footage Food Handlers Course required: Yes No <br /> with Food Preparation DVending Machines Number of Units <br /> with Meat Market only Multiple DepartmentsC Prepackaged Goods Only <br />Vehicle Type |\/]T4 Color Red <br />License # NZW1 554 Sticker # <br /> Vehicle Type <br />Sticker # <br /> z i <br /> Small Generator Limited Hauler <br /> 11 - 60 > 60 generators <br />SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />MASTERFILE RECORD INFORMATION FORM <br />□ New EH Program at Existing Facility~S^lew EH Program and New Facility <br />Facility ID Program Record ID <br />FacilityAddress 1311 Yosemite Ave Manteca, CA 95336 <br />(Please check the appropriate description and specify size, number of units and pertinent information ) <br />FOOD PROGRAM (1600) <br /> Restaurant: Seating Capacity <br /> Commissary Dry storage only <br />□^Retail Market—Square footage <br />^StMobile Food Vehicle —Make |— pejnhtlinSF <br />Registration # Tpy^q ' " <br /> Mobile Food Prep Unit <br />Registration # <br />^-Temporary Food Facility -Dates of operation from <br /> Special Event Dates of operation from <br />DAIRY PROGRAM (2000) <br /> Grade A Dairy Grade B Dairy <br />CUPA State Facility Surcharge (2399) <br />HAZARDOUS WASTE PROGRAM (2200) <br /> Hazardous Waste Generator <br /> CRT Offsite Handlers (2218) - <br />Tiered Permitting Facility-------- <br />Tons Generated Per Year <br /> Silver Only (2222) <br /> Conditionally Authorized (CA) <br /> Permit-By-Rule Fixed Unit <br /> ABOVEGROUND STORAGE TANK FACILITY (AST) (2390) Number of AST <br />UNDERGROUND STORAGE TANK (UST) PROGRAM (2300) Use US7 A and B forms <br />HOUSING PROGRAM (2400) <br /> Hotel/Motel------Number of Units Jail or Exempt Institution -—Number of Units <br />Employee Housing (2700) Use Employee Housinq/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 <br /> Abandoned HW Site non-NPL/SEP Cleanup Site RWQCB Cleanup Site <br />RECREATIONAL HEALTH PROGRAM (3600) <br />Number of Pools/Spas at Facility <br />VECTOR CONTROL PROGRAM (4000) <br /> Poultry Farm-------Maximum number of birds <br />TATTOO, BODY PIERCING, PERMANENT COSMETIC PROGRAM (4100) <br /> Tattooing (4121) Body Piercing (4120) <br />LIQUID WASTE PROGRAM (4200) <br /> Pumper Vehicle Registration # <br /> Pumper Yard <br />SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station <br /> Waste Tire Facility Compost Facility <br /> Refuse Vehicles (# of Units) <br />MEDICAL WASTE PROGRAM (4500) <br /> Primary Care Acute Care Skilled Nursing Large Generator <br /> Transfer Station Veterinary Clinic Common Storage Facility 2 -10 <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 Jared Schwertner <br />Program Element | S Fee i S 2- r CTO <br />Inspector# y Permit Valid ’V'SHZ/ <br /> Check# <br /> Cash