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SJ COUNTY PHS - ENVIRONMENTAL HEALTH DMS'– MASTERFILE RF—RD INFORMATION FORM {EH 00 591Reviaed a/sal} <br /> New EH Program iF-listing Facility F New EH ProgramiNew Facility [ Date k <br /> SHADED SECTIONS FOR LOCAL USE ONLY Q' <br /> FACILITY ID # 00� 9 RECORD ID # 5D-704 <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Units where applicable: <br /> DAIRY PROGRAM {2000} <br /> Grade A Dairy Grade 8 Dairy Milk Dispenser Ntmber of Containers in Multi44ord Unit <br /> FOOD PROGRAM {16001 <br /> I <br /> Restaurant Senting Ca°acity I Square Footage Produce and Ice Plant <br /> ' <br /> I <br /> Commissarry oraOStge only 1 with Fwd Preparation ---�FVndinq Machines Unit. <br /> Nwnber of <br /> 1 Smrnra Pomace I with Ment Mark-cnly I with F—d Preparation I Dry Goods only <br /> Retail Market <br /> I Make 1 Vehicle Type ' Color ; Rsgimmuon 0 i Ucense X <br /> Food Vehicle <br /> I Make I Vehicle Type I Color I Regis.adan X I ucenss X <br /> Mobile Food Unit I 1 I I I <br /> Temporary Food Facility Special Event <br /> Dates or operation Iran to Dates of 006,060. from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> I Tons generated per yearIL, �} T-y"^, ,� " t r� <br /> Hazardous Waste Generator ll �� <br /> 1 <br /> 1 Categorically authorized Cetegoricdly Enanpt Permit by Rtde <br /> Tiered Permit Facility <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Number of Unita Number of Enployess DOiry C7rhployee Housing I! <br /> Fwotel <br /> AOProsimwte oat"of Occupancy <br /> xempt Institution tO <br /> LIQUID WASTE PROGRAM {4200} <br /> I Registration X 1 Ucense X 1 Cauactty I Vehicle X <br /> Pumper Vehicle t <br /> Number of Unita <br /> Pum er Yard Packs a Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursing Lar a Generator <br /> Shall Generator Transfer Station Limited Hauler Veterinary Clinic <br /> I 2-10 generators 11-60 generators >60 generator. <br /> Common Storage Facility I <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> E <br /> S a Out Gf Service Pool/S a Natural Bathin Areaf Pools/Spas at Facility Pool/Spa ID X - II <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> 1 Cel EPA-RW OC8 I Cd EPA-OTSC I US-EPA <br /> Other Lead Agency Site <br /> 1 NPL Site I Water Ouaiity Site I Other <br /> SOLID WASTE PROGRAM {4400} <br /> l <br /> Landfill Transfer Station Aq/Cannery A /CanneryWaste Site <br /> Nwnber of Units <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Nanbs,of Units <br /> Waste Tire Facility Process/Recycle Facilityum Dsters >20 cu yd <br /> VECTOR CONTROL PROGRAM {4000} <br /> Masim„m Ntsnber of Bids <br /> Farm Kennel <br /> Poultry <br /> Snergoncy Noofinalion for(lus FACIUTY andlor PROGRAM a" Nlght <br /> CONTACT PERSON: <br /> Designated Employee 1 Program Semens X --/ -7 --� Current stauta Nwnber of Units EPA lO lr <br /> r cehved by Uate Revhewad by ate Aceoungng Olhce Date U,at C s,k Data nt to aha <br />