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SAN JOrAQUIN COUNTY ENVIRONMENTAL H ` � MASTERFiLE RECORD INFORMATIp(�AaR D!P:AT6UIENT❑Ne=--�?I�.9�am at Existing FacilitFacilit IU r a '� - —�-NeW E� ogram and New Facilit h,F��gQU/� ®�� �'��C1l6{�/AC�G�6OSS 7� 7 Pro ram Record Ifs (Please check the appropriate description and sp fy�e numb n TH pEp; Cou 4 �. . /I �. FOOD_ PRO .r1{']C�00) 'J W Restaurant: Seating ; number of units and eminent information.) ❑ Commissar; ❑ D g Capacity_�'"I t! '1 ry stora e Square Footage ❑ Retail Marl<rai_.__� g only ❑ Witll Food Preparation Food Handlers Course re square footage paration C>`✓endillc uireJ; YES❑ Mobile Food Vehicle--Make J Machines No ❑ ❑ with Meat Market only ❑ Multiple De a Number of Ullits�_ Registration# Vehicle Typcj p rtments❑ Prepackaged Goods Only ❑ Mobile Fooc!Prep Unit License# Color Registration# Make __ —�--�_ Sticker#_ ❑ Temporary l=pod Facilit —ofy Vehicle Type - ❑ Special Eveni Dates Ofope--Dates from elation frons License# to Sticker# Color DAIRY_ P_ R—ki (2000) --�--- ❑ Grade A Dairy t0 Ice Pl-- ant ❑ Grade 6 Dairy ❑ Produce Stains;{ CUPA ❑ Stao Facility ❑ Milk Dispensor-Number of Containers in Multi-Head Unit HAZARDOUS Utir, Surcharge(2399) ASTPROGRAM(2200) ❑ Hazadous Waste Generator---- -------- ❑ CRT Onsite Handlers(2218) ________ Tons Generated Per Year Tiered Fernlitting Facility ____ ---❑ Silver Only(2222) ❑ Recycle/>=xempt Sysfi�rn (2299) "---'----- ❑ Conditionally Authorized(CA ❑Appliance Recyclers(2217) ❑ Permit-B ) ❑ Exempt Conditionally Ext ❑ ABO'e E';ROUND STORAGE TANK F- Y Rule Fixecl Unit (CE) UNCE?UROUND STOP,/�G ACILITY(AST) (2390 N�Imber of AST❑ Permit-By-Rule Household Hazardous WasteHOUSING PRO22AM(2400) E TAMC(UST)PROGRAM (2300)Use UST A and B forms ElHotel/Motel--Numbe Cf mployee Housing(2700)Use Emplovee k1ol labor Camp Application l°rm E] Jail or E;;e,lrpt Institution----Number of Units S' EMI_MITIGATION 1 0) UNDERGROUND INJECTION CO TR C Environmeriaf Assessment UST-CAP Site ---N—QI(3000) ❑ Abandoned i fv Site ❑ Local HW Cleanup Sh. ❑ non-Nf'L/Sk.P Cleanup Site ❑ RWG�C^ ❑ NPUSEP Cleanup site RECREATIONAL H-SALTH PROGRAM(3600) t Cleanu Site p ❑ UIC S!t`= p ❑ Water Qualifi Number of Pools/Spas at Facility ❑ poo( y Remediatiora VECTOR CONTkO=PROGRAM(4000) ED Spa C' Cut Of Service Pool/Spa ❑ Natural Bath in I 13 Poultry Farm-----Maximum number of birds g-krcel TATTOO.BOGY PIERCING.PERMANENT COSMETIC PROGRAM(4100) ❑ Kennel Tattooing ±2 i f --- LlC)UlD WASTE!'f'CGRAM(4200) ❑ 130dy Piercing(4120) EJ VehicfeReglstration# ❑ Permanent Cosmetics (4122) ❑ Pumper Yard License# ❑ Packacle Treatment Plant Capacity —_ Vehicle# _ SOLID Rn012AM(4400) El Chemical Toilets----Number of Units___ ❑ Landfill ❑ Transfer Station ---'+- ❑ Waste Tire Facility ❑ Compost Facility ❑ Ag/Cannery UL'astO Site ElRefuse Vehiclss(#or Units) 11Process/Recycle Facility El Site MEDICAL WASTE=_hROGRA ❑ Dumpsters>20 cu yd f#of units ❑ Ch-,Landfill Site —im ISI(4500) 1 ❑ Farm/Ranch Cleana3p Site ED Primary Carr ED Acute Carec- ❑ Transfer Stauoli E3 Veterinary ClinicQ S tilled Nursing ❑ Large Ceneraior ❑ Small Generator ❑ Limited H�r,.aer Common Storage Facility IFICATION F❑ OR THIS FACILfI-Y PUBLIC WAWATERSPERSONy_TEM PROGRAM GRAM(4600) Use PIM,S EHD 46-02-003 Blue ff,nnlica(loaF°rm0 E] 11 -60 ❑ >60 generators p MERGEA'CY NOT ,grID/OR PROGRANf CONTACT PERSON i�, PROGRAM ELEMENT 2/,, Day Ph qi_> -� FEE Z, Night Ph LSI� INSPECTOR ❑ Surch # ar FE - to CJ Other FL-:c- Cash i,= _ PERMIT VALID Z q Check# /�q�/,AMOUNT PAID ! CI Food Handler Cash �� Date /l5 _ -REVIEWED B- 2 ACCOUNTING OFFICE INVOICE# � Date_ d 48-02.034 / 11/15/07 MASTERFILE RECORD INFORMATION PIIJI<