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SJ COUNTY PIIS-ENVIRONMF.NTAI_IIEALTII DIVISION MA37TFAF1I1flkt:uRu IIVFuRlPA0074fOTM t-elfLTD a °7�T► <br /> Naw EH Program/Existing Facility New EH PrograntlNew Faoility <br /> SHAL5ED SECTIONS FOR LOCAL USE ONLY <br /> FAC_ILIT_YID # V. CORb ID:# I _ <br /> J <br /> planes Mark the Appropriate Deeorlptlon and Speoify Size andlor Number of Unite where appkonblel 1 <br /> DAIRY PROGRAM {2000} f ! <br /> Ond•A Ddry Gnde 8 Daily Milk Dbpenrer Number of Cont-111016 In MdU Head Unit <br /> r 1� <br /> FOOD PROGRAM {1600} <br /> I <br /> I <br /> 1 Sooting capaolly I Square footage Odl1Ce Ste d c8 Plant <br /> eeteurent t t <br /> Nunb•r of Urdu <br /> 1 Dry Sturge only 1 will,Food Preporadon V_ ndi eC ll es <br /> Co_mmleee► <br /> W I Bquefs Fool.g• I Willi Me@t Markel way 1 with Fund Pfep.r.dun 1 Dry Goods ody <br /> 1 <br /> make 1 Vel,lols Type 1 color 1 Regletr•don / 1 Uoems 1 ! <br /> [Food Vehicle 1 I I 1 f <br /> t t <br /> 1 Make I V614.1.Type 1 color Regeu•Uon / Uoau• 1 <br /> Mobile Food Unit 1 1 t t <br /> t 1 <br /> I <br /> Temporary Food Facility Special Event i <br /> Date@ of Opefedun Irma to Uma of Op•tadon front to <br /> HAZARDOUS WASTE PROGRAM f 2200 ! <br /> 1 Ton.genef■ted per year <br /> Hazardous Waste Generator <br /> 1 Caapodadly wthod.ed f Ceuymlodly Exempt 1 Permit by Was <br /> Tiered Permit FacilityI <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> 1 Number of Ude@ Number of 6nploy•ee Ddry 6nployee wueing <br /> ote Motel <br /> Appto.bnate D■ter of Oooupanay <br /> Jailor Exempt Institution to <br /> (JQUI) WASTE PROGRAM {4200} <br /> 1 fl.gl.uadon/ 1 Uosnee / I csp•olty 1 Vallols 1 <br /> Pum er Vehicle <br /> � Nunb•r of UdU � <br /> Pum er Yard Pecks a Treatment Plant Cltemlc d Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Prima, Care Acute Care Skilled Nurain erne Generator <br /> Limited Hauler Veterinary Clinic <br /> Small Generator Transfer Station ; <br /> 1 r, <br /> $ 10 gena■wr I t t •60 generator f >60 geantor <br /> Common Storage Facility <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool Still --Out o Se v ce 001/15val us Bat tl A en <br /> Number of Poole/Sp.. at F.olllly �po116p■ID# F f <br /> SITE MMGATION PROGRAM {2900} <br /> Environmental Assessment US ICA Local tiaz.Waste Hez Met Pipeline <br /> I Cd EPA-RWGCB I Cd EPA-pTBC 1 uS.EPA <br /> Other Land Agency Site ! <br /> 1 NPL Site 1 Wolof Ouellty site I Other ' <br /> li <br /> SOLID WASTE PROGRAM {4400} <br /> i <br /> Landfill Transfer Statin Afl/Cannery Weare Site <br /> Number of Urtla �• <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vahlcles <br /> Waste Tiffs Fecllt Procese/Rec cls Facillt <br /> Dum eters >20 cu d Nts'►l er of unit. <br /> VECTOR CONTROL PROGRAM {4000} <br /> M.xhnun Number of Birds KeMeI t <br /> Poultry Farm <br /> 6nergenoy Nodfloadon for dde FACIUTY and/or PROGRAM <br /> Day Night <br /> 1 <br /> CONTACT PERSON: ��� , t t 't - � (•� �1 I= ( ( i <br /> pro ran t3arnom 1 ;urr►nl 6totue I Number o!Urdu EPA ID 1 <br /> Derl pl�tW 6npluy.e 1 g 1 <br /> sue <br /> ad ea ev ewer y ate oaount m Oa as i l rr 777777= <br />