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• SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT <br />MASTERFILE RECORD INFORMATION FORM PgYM N <br />O New EH Pr ram at Exlstin FacllIII <br />Facili ID �� New EH Program and New Faclllty AU <br />1 11, 111111-1 1 Pr ram Record ID <br />Facility Address 1328 S Hunter Street Stockton, CA 95206 SANCo811 A / 8 ?021 <br />(Please check the appropriate description and specify size, number and pertinent information HFACTH O /ROOMEN 41 Ty (1800) Drive Thru----__) ART L <br />r Restaurant: Seating Capacity 0 Square Footage 450 4I <br />❑ Commissary ❑ Dry storage only ❑ with Food Preparation'Food Handlers Course required: <br />erred: YEs No ❑ <br />❑ Retell Market --Square footage []Vending Machines Number of Units <br />❑ Mobile Food Vehicle -Make ❑ with Meat Market only ❑ Multiple Departments❑ Prepacka ed <br />Registration # Vehicle Type 9 Goods Only <br />❑ Mobile Food Pre License # Color <br />Prop Unit Make Sticker III <br />Registration # Vehicle Type <br />❑ Temporary Food Facility -Dates Of operation from License # -_ Sticker # -Color <br />❑ Special Event Dates of operation from to ❑ tinker IPIP t <br />DAIRY PROGRAM (2000) to ❑Produce Stand <br />13Grade A Dalry 11Grade B Dairy 13Milk Dispenser -Number of Containers in Mufti -Head Unit <br />COPA ❑ State Facility Surcharge (2399) <br />HAZARDOUS WASTE PROGRAM (2200) <br />❑ Hazardous Waste ) Generstor <br />❑ CRT Offsite Handlers ( 2218 Tons Generated Per Year 13Recycle/Exempt System (2299) <br />❑ Silver Only (2222) <br />Tiered Permitting Facilitypliance <br />❑ Conditionally Authorized (CA) 13Conditionally E elmpt((CE) ) <br />❑ ABOVEGROUND STORAGE TANK FAO erASTPermit-By-Rule Fixed Unit 13Permit-By-RuleHousehold Hazardous Waste <br />UNDERGROUND STORAGE TANK (U PROGRAM (3 p) Use LISTA_ Q1 gjU2MR <br />Number of AST <br />HOUSING PROGRAM (2400) <br />❑ Hotel/Motel --Number of Units <br />Employee Housing (2700) Use Employee /l ^l8W ebor Camp Apol0 Jailtion or <br />Form, Exempt Institution --Number of Units <br />METE MITIGATION (2900) UNDERGROUND INJEGTIO�CONTROL (3000) <br />❑ Environmental Assessment ❑ UST -CAP Site <br />11 Abandoned HW Site ❑ Local HW Cleanup Site ❑ NPL/SEP Cleanup Site <br />❑ non-NPUSEP Cleanup Site 13 UIC Site <br />RECREATIONAL HEALTH PROGRAM (3600) ❑ RWQCS Cleanup Site 13Water Quality Remediation Site <br />Number of Pools/Spas at Facility _ ❑ pool <br />TOR CONTROL PROGRAM (4000) ❑ spa 11 Out of Service popUgpe ❑ Natural Bathing Area <br />❑ Poultry Form ---Maximum number of birds _ <br />TATTOO BODY PIERCING PERMANENT C9 1,ETIc PR C] Kennel <br />100) <br />❑ Tattooing (4121) g (412 <br />LIQUID WAST�R� M (4200) 13 Body Piercing (4120) ❑ Permanent Cosmetics (4122) <br />❑ Pumper VehicleRegistration # <br />13 Pumper Yard License # Capacity <br />❑ Package TreatmentPlant Vehicle # <br />SOLID WASTE (4 400) ❑Chemical Toilets --Number of Units <br />❑ Landfill ❑ Transfer Station <br />❑ Waste Tire Facility ❑ Cq^ ❑ Ag/CanProces nary Waste Site ❑ Sludge/Ash Site <br />❑ Refuse Vehicles Oa Units) P� Facility ❑ pro psterseeycle Facility 13 CIA Landfill Site <br />MEDICAL WAU PR ❑ Dumpsters > 20 cu yd ryr a u�rcsl ❑ Farm/Ranch Cleanup Site <br />❑ Prima Ca- r�"� (4�) <br />Primary ❑ Acute Caro ❑ Skilled Nursing ❑ Large Generator <br />❑ Transfer Station ❑ Veterinary Clinic 11 Small Generator ❑Limited Hauler <br />PUBLIC WATER SYSTEM <br />13 Common Storage Facility ❑ 2 - 10 <br />� M ��°M (4600) Use PWS EHD 18.02 ❑ 11-60 ❑ > 60 generators <br />_ppa ar eAp il'lce6•an Form <br />Fuen..�.... <br />CONTACT PERSON Horatio Guerrero TY <br />Day Ph 209 969-0921 <br />PROGRAM ELEMENT Z FEE Night Ph 209 740209 740-2�_ <br />INSPECTOR # > ❑ Suroha e F E ❑ Other FEE <br />PERMIT VALID rC t0 � .3 <br />heck * AMOUNT PAID E3 Food Handler <br />❑ Cash Date S INVOICE# <br />REVIEWED 9Y ACCOUNTING OFFICE <br />Date 8 <br />ea-o2-oae <br />11/15/07 <br />MASTERFILE RECORD INFORMATION PINK <br />