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eSJ COl1NTY F'IIS -ENVIRONMENTAL IIEALTH DIV MASTETIFII.F )RD INFORMATION FORM (Ell 00 60I11ev1-1 ereai) <br /> ILNew Ell PtogranilExisting Faoility New Ell PrograntlNew Fauility 11 Date 1 <br /> SHADED SECTIONS FOR LOCAL USE NL Y <br /> FACILITY Id # LAI RECORD ID # <br /> Please Mark the Approprlale Desuription and Speoify Size andlor Number of Unite where applio.ble: <br /> DAIRY PROGRAM f 2 01 <br /> _ <br /> Orad.A Udry Grade a Deily Milk Olgwnew Nm,bar of Cont l—s In Muni head Ud1 <br /> WL t-TH <br /> Foot) PROGRAM {1 6001 r INV" rim S <br /> 1 <br /> I 6andny Cep.olly I squaw Foolaya <br /> Reetaurnnt I oduce Stand ce Plant <br /> 1 pry storage ody I with Food Pr.p.w duu" Nunbu of UrJt. <br /> _Comnllesnr Vendlr�Macillnes <br /> I Bqunr•Fow.y. 1 with Mont Mruk.t urJy 1 will,F.,od Pr.p—llun 1 Dry Ouod.oldy <br /> LR--L-J, <br /> 1 Mak. 1 VeIJ.I•Type I Culot 1 Raybu.don/ 1 Uwn.• / <br /> Food Vehicle 1 1 I 1 I <br /> 1 1 1 1 1 <br /> 1 Mak. I V.140. Type I C.la 1 R.yletradun / 1 Uonw/ <br /> Mobile Food Unit 1 I I I 1 <br /> I 1 1 I I <br /> Temporary Food Facility Special Event <br /> D.1..of Opuedmt hom to Dau•of OpuaLlon born to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> 1 Ton.yen.r•ad par year <br /> Hazardous Waste Generator <br /> f Cat.yodo.ly authorized 1 Catagadoally Exampt I P.nnit by Rd. <br /> Tiered Permit Facility <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Nunbar of Udts Nunbar of 6—ploy... Ddry 6nployee Roaring <br /> Hotel Motel <br /> Appio.lrnaw Data.of 0...panoy <br /> Jail or Exempt Institution to <br /> LIQUID WASTE PROGRAM {4200} <br /> 1 Rrio.uadon I 1 Uoau• / 1 Cap.olty 1 V.N.I./ <br /> Pumper Vehicle 1 I I I <br /> j <br /> Pumper Yard <br /> Package Treatment Plant Chemical Toilets Number of UrJIs <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Ninsina Larrie Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facility <br /> 2-10 y.n.ratois I 11 -60 geg.".1.1019 >60 g...far.,. <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool Spa Out of Service Pool/Spa Natural Bathinil Area <br /> Nunbar of Poul./Spas at F..11hy Poollbp•ID/ <br /> SITE MmGATION PROGRAM {2900} <br /> ff011t.r <br /> ental Aseessment UST/CAP Local Haz Waste Haz Met Pipeline <br /> Cd EPA-RWOCs I Cd EPA-DT&CNOV t l �Ad Agency Site 1 <br /> 1 NPL 61ta 1 Watar Ouallty site 1 Other <br /> Soup WASTE PROGRAM {4400} PUBLIC HEAT 'JrVI ES <br /> lY ' <br /> Landfill Transfer Station AfIfCannery Waste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Nunbar of udt. <br /> Waste Tire Facility Proceee/Rec cls FacilityDum stere >20 cu yd of urdl. <br /> VECTOR CONTROL PROGRAM {4000} <br /> Maxlmt.n Nunbar of Birds Poultry Fenn Kennel <br /> finny.my Nudlio.dmt fur Ude FACILITY and/or PROGRAM Day Night <br /> CONTACT PERSON: U <br /> D/�qpr tsdE+n luyea• PrOplatn Element 0: Currsnl stews Nunbar of Ulgis EPA ID# <br /> .nava y ala aV swrl y alb All n n9 1 04 Unit Clark Vole UnitSIR[ ate <br /> _. -. _ ._.. _.. _.-. _.,_._...___ _ ._. '�.�,�.��.. m•raa ams <br />