BILLING - Laserfiche WebLink

Home Browse Search

SAN JOAQUIN COUNTY ENVrLR.ONMENTAL HEALTH.DEPARTI��FNT NIASTERFILE L: RD INFORMAM 4ATION FOR ❑New EH Pro ram at Existing Facility New EH Pro ram and New Facility Facility ID r- 10 O t'(,,(-- Program Record ID Facility Address C�'2--2 L—i r o __ ��•P (Please Check the appropriate description and specify sig number of units and pectin nt information.) FOOD PROGRAM(1600) ❑ Restaurant: Seating Capacity Square Footage Food Handlers Course required: YES❑ No ❑ ❑ Commissary ❑ Dry storage only ❑ with Food Preparation ❑Vending Machines—Number of Units ❑ Retail Market----Square footage ❑ with Meat Market only ❑ Multiple Departments ❑ Prepackaged Goods Only ❑ Mobile Food Vehicle-----Make Vehicle Type Color Registration# License# Sticker# ❑ Mobile Food Prep Unit--Make Vehicle Type Color Registration# License# Sticker# ❑ Temporary Food Facility-----Dates of operation from to ❑ Ice Plant ❑ Special Event --Dates of operation from to ❑ Produce Stand DAIRY PROGRAM (2000) ❑ Grade A Dairy ❑ Grade B Dairy ❑ 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 Facilit)------- ❑ Conditionally Authorized(CA) ❑ Conditionally Exempt(CE) ❑ Permit-By-Rule Fixed Unit ❑ Permit-By-Rule Household Hazardous Waste Cl ABOVEGROUND STORAGE TANK FACILITY(AST)(2390) Number of AST UNDERGROUND STORAGE TANK(UST) PROGRAM(2300) Use UST A and B farms HOUSING PROGRAM(2400) ❑ HoteUNlotel-------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 }IW Site ❑ non-NPL/SEP Cleanup Site ❑ RWQCB Cleanup Site ❑ Water Quality Remediation Site RECREATIONAL HEALTH PROGRAM(3600) Number of Pools/Spas at Facility ❑ Pool ❑ Spa ❑ Out of Service PooUSpa ❑ Natural Bathing Area VECTOR CONTROL PROGRAM(4000) ❑ Poultry Farm- Maximum number of birds ❑ Kennel TATTOO BODY PIERCING PERMANENT COSMETIC PROGRAM(4100) ❑ Tattooing(412 1) ❑ Body Piercing(4120) ❑ Permanent Cosmetics(4122) 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--Number of Units ❑ Dumpsters>20 cu yd ----Number of Units ❑ Farm/Ranch Cleanup Site MEDICAL WASTE PROGRAM(4500) ENVIRONMENTAL HEALTH ❑ Primary Care ❑ Acute Care ❑ Skilled Nursing ❑ Large Generator DEPARTMENT NO LONGER 11Transfer Station ❑ Veterinar} Clinic ElCommon Storage Facility-----❑ 21 INSPECTS WASTE TIRE PUBLIC WATER SYSTEM PROGRAM(4600) Use P{f S EHD 46-02-003 Blue ADDlication Fo, FACILITIES It is a State run EMERGENCY NOTIFICATION FOR THIS FACILITY ANDD program effective 7/1/2017. CONTACT PERSON Day Ph f-- ��,.-.--• PROGRAM ELE/MIEN-,T Lf-7lf O FEE S ❑ Surcharge FEE ❑ Other FEE ! INSPECTOR# Yv?j(O PERMIT VALID to ❑ Food Handler E ❑ Check 4 AMOI NT PAID Date INVOICE# f ❑ Cash REVIMED13Y ACCOUNTINGOt:rICE 2� Date 4R-02-034 Masterfile Record Pink 11118103