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oc <br /> wizyrr rn9-clyvmUNMENIALHEALTHDIVISION MASTERFILE RECORD INFORMATION FORM{EH 00 6Svbu,ie.d a/aqQ <br /> IdayeFJ+Pro rem/ExiatingFacility C New EH Program/New Facility }` F out. <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> FACILITY ID # RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Unite where applicable: <br /> DAIRY PROGRAM {2000] <br /> Grade A Ddry Gmtle B Odry Milk Dlvpenwr Nwnber of C.dath e.In Mdd-Head Unit <br /> FOOD PROGRAM {1600] <br /> Restaurant I meeting Capaciry I Square Foomye <br /> Produce Stand Ice Plant <br /> I Dry Storage only 1 with Food P....mtlon Number at Unit. <br /> Commissar <br /> Vending Machines <br /> Retail Markel I Square F...... I with Meat Market any 1 will,Foad Prepared.. I Ory Goode oNY <br /> Food Vehicle I Mark. 1 V.N.I.Typ° I color I Reglrtmtlon If I Uamu! <br /> I 1 1 I <br /> Mobile Food Unit <br /> Make 1 Venal.Type Color i gegbtretlon! i Uoeme Y <br /> I I <br /> Temporary Food Facility [Sp....l.10E,ent <br /> Vale..1 Operadon from to of peratlan from m <br /> HAZARDOUS WASTE PROGRAM {2200] as <br /> I Toll.genemtad per Yea, 2' <br /> Hazardous Waste Generator J <br /> Tiered Permit Facilit i Categ.dcuty authorized Categorically Exempt Permit by qni. <br /> HOUSING PROGRAM {2400] EMPLOYEE HOUSING {2700] <br /> Hotel Motel I Number of Units Number o1 Employ.a. Deny Eirdoyes Housing <br /> Approplmete Dem°.10...Panay <br /> Jail or Exempt Institution to <br /> LIQUID WASTE PROGRAM {4200] <br /> Pum er Vehicle I lu gl.nauon Y I Ucan.e ! I Capacity I Wed.Y <br /> Pumper Yard Packs a Treatment Plant Chemical Toilets 1 Number of Unite <br /> MEDICAL WASTE PROGRAM (4500) <br /> Primer Care Acute Care Skilled Nursing Large Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Stora2e Facilityj aaneretor. 11 -50 g,cNNu,,. i >50'..-ton, <br /> RECREATIONAL HEALTH PROGRAM (3600) <br /> Pool I Spa Out of Service P..[/SpaP..[/Spa Rutting Area ----I <br /> Numbs,of Poole/Spee et Fecilry Pool/Spa ID IF <br /> SITE MITIGATION PROGRAM (2900) <br /> Environmental Assessment I UST/CAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site 1 Cal EPA-RWGCa 1 Cd EPA-DTSC I USEPA <br /> 1 NPL Site I WIN,Ouellry alta I Other <br /> SOLID WASTE PROGRAM {4400] <br /> Landfill Transfer Station Aq/Cannety A /CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash SiteCompost Facility Refuse Vehicles Number of UN. <br /> Waste Tire Facility Process/Rea cls Facility Dunt stere >20 cu Ind Nunber of unite <br /> VECTOR CONTROL PROGRAM {4000] <br /> Poultry Farm M°*fawn Nwnb.,of Bird. Kennel <br /> Emergency Nodficedon for M.FACWTY and/9r PROGRAM Day Night <br /> CONTACT PERSON: %tib ice/ (7<--'y )36:x-yny/c,�;/<'-// 1 ) <br /> D9.ignuted EdPl...9! program A.......I# current Stora. Number of but. EPA ID f t^ ryry <br /> C�hh�lJc <br /> rwomeul by Data W <br /> aViee y ate Unllllg 0111a.. pfe IJOTMck Date 1 t 1a son <br />