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GENERAL PROGRAM FILE : New Change Edit (PROG3) revised 5/21/93 <br /> FACILITY iD / 7�• 1 FACILITY NAME - -,yip - y <br /> RECORD ID f! PRIOR SVEWS/COMP <br /> DAIRY: grade A Grade a Ml lk Dispenser Nunber of Containers in Multl-Read Un <br /> tt I <br /> FOOD: Restaurant _ Market - Commissary _ ' Mobile rood Produce Stand _ Ice Plant <br /> Seating Capacity Sq rt - Mnrket W/Food Prep: Y _/ N - - - <br /> Teiporary Food Facility Special food Event Vending Machines Nunber of Vending Unite <br /> Food Vehicle _ Meke - < LIcen+e 0 RegIstratiai 0 Color. <br /> HAZARDOUS WASTE: Torts Generated/Yr �` TIERED PERMIT Fact l try CA CE FOR <br /> HOUSING: Notei/Motel No. of Uni to Jawexeept Institution Housing Abattment - -' <br /> Etryloyee-Nous Ing _ No. of Eaployees -wl Approx.Dates of Occupancy _J_I to <br /> < { - _ -LIQUID WASTE: Ptnper Vahlele punper Yard: - Chemical Toilets _ No. Package 7x Plant _ <br /> - .. <br /> MEDIC AI. WASTES Primary Care Acute Care Skilled Nursing Lg Generator= Sm Generator _ <br /> Storage (2-10) _ Storage (11-50) _ Storage ( 150 } - <br /> Transfer Sta Ltd Neuter __. .Yet Cl tote <br /> RECREATIONAL HEALTH: Pool/Spa Nutter of Pools Out of Service Pool Natural Bathing Place <br /> SITE MITIGAT ION:L" Ewl ran Assess , UST/CAP['_ Lac Hex waste Ha: Mat PPL <br /> her cad Agency Site ie Y' <br /> - RWOC9 DISC NPL Site -__ RB/N20 0 — Other <br /> _ SOLID WASTES Landfill. " Transfer Ste ,Recycling Fee - Waste Storage Fee Ag Waate/Ext'npt Site <br /> SY Vehicle No.. ',{ Duni++ter _ No. Stationary Con"ctor Site <br /> _ VECTOR CONTROLS Poultry Farm_- Max Nur rt of alyds Kemal _ <br /> EMERGENCY NOTIFICATION for this FACT L I7Y and/or (PROGRAM - <br /> DAY : NIGHT <br /> s <br /> CONTACT 1'r <br /> ` CONTACT 2 <br /> DO GNAT EMPLOTEE 1 7 Ir PROGRAM ELEMENT / a Q' - CURRENT STATUS <br /> y h <br /> NSPECTION CODE <br /> - 9 OF UNits'f �� EPA ID f•: + j;,i <br /> oJect si if le IANCEND E'DGEMENTS 1, the undersigned owner, operator or spen1.t of ss, L% _'acknowledge that Ott Oto anA�lor k„ tl�, <br /> BI LUNO end COMPLIANCE A •, - - <br /> . 'pr pc hourly charges associated with thio feellify or activity will be„billed tetM )Berry Idm[(fted es• the s f,:; <br /> i <br /> BILLING PARTY on thfa`fora'. I alse`tertify;ehat ( have Prepared this application end that the War to b performed will'Da dura <br /> In accordance with all applicable SAN JOAOUI TY rdiname Codes:and/or Standards and state*and/or federal ISSws <br /> APPLICANTr9 9111NATUIIE t >.: L 'f' < -�} f y r -ga •4*r sMw`� ' <br /> itlasc?�lid� 19�L'79La(✓15 it ` Dates , , k x�nW- <br /> T <br /> AUTHORI2ATId1 TO RELEASE INFORMATION t In addition to the•above when a licsble " 1 the ow r rotor or pen! of same,”,o/�' u�>vd�,_� <br /> e PP ,:d 3"­*r ' � �w rp .q .�r -:"' <br /> the prapertytloc:itd st:the above site address Hereby auth6rrlxarthe`relesse of sny,ard all�pesultrpeotechnieel,date, kotr ` 'itik : <br />!� ernlr:Nraerttsl/alts assestmmt inforpmt Tonto SAN JOAOUIN,COUNTY PUBLIC HEALTH S!7;e ES Eq AL HEALTH DIViSIONrss0eoon <br /> It Is oval Iobie and st the SO",time it la provided to eNr or�,my represetntetiw <br /> ., x ,u{•.n.iwwa.a < v M.sx.a wN1 w;:'W A I i:W W `5a w Y .• - �• <br /> s c..p t r z✓r�'r?t Fv a;l. aM.e v {.,i� -A" 570 y, �w �- <br /> fee Amotnt AewttSPsld Frr TDete.,of Ps}ment nti Pa)+nent Types •NaesiPt MCheek <br /> 'A st*...ran' v� 'trsdi fi-r fi -1''`. c✓n A%"4`f^SY .�"'4+� tw,� 4�" rf3-^+k >fim "f1. �R•`�'M''a ' 3}3Y Ftuih 7 /k »3. fii*t�i "S?R. . nv '3. <br /> '' i � w+n^x cr wi '+e�B st br' �" 9 a t "�'*• u� ' � 4 �. t'iy.y�?t�t 'Waf ♦w� }�`�x t d �U .;�: <br /> F" �' v ?eS.r �4'3S ¢¢* ''`-`r n,. 'v4� n rvx'`'}'$ � t1.8b'y§''D�e F�; iy' +Ce r y� y4 s•� anY4 x �i s <br /> .i.K� Rte'"'rte :#�( T3'�+ ��'d"b8t'Cs i+MN,�e)" �f4.53'W`�„FT"i.urt?"�,a 'fit` #.;.'.�?'1^.e7"b'�t'^��✓v tCi v'v�°v 4u3g 3�^:,t.� i t't a"' 3%nRi'S J'�`&4�.�i"ry�"+.T '44ht c4S�1S{ "a,, <br /> h <br /> UNIY CL a 'ik 'ulk''fi spu <br /> RENS+, eTv�" m v6 53 +A"•+ `SUPV `-� </r / r+s ACCft°,na /—� <br /> 'M '�FY' <br /> r ..Y}"�_�.A .=`%��*-^r•'tri,�.��.i��:-��r,�,'"t_�,?w�-��c�.yv '3L` a�!_.��.r+"hh.w., r�ds�(;`���v� .i <br />