Laserfiche WebLink
SJ COUNTY PHS-ENVIRONMENTAL HEA TH DIVISIJR MASTERFILE RF ) INFORMATION FORM {EFF 00 5918-1.od 6/94)} <br /> New EH Program/Existing Facility New EH Program/New Facility I Date <br /> SHADED SECTIONS FOR LOCAL US ONLY <br /> y <br /> FACILITY ID # RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Units where applicable: <br /> DAIRY PROGRAM {2000) <br /> Grade A Dairy Gr i.B Dnir Milk Dispenser Number of Containers in Multi-Head Unit <br /> FOOD PROGRAM {1600} <br /> 1 Senting Ca acity 1 Square Footage <br /> ' Restaurant Produce and Ice Plant <br /> i Dry Strnngn only 1 with Food Prnpnrntinn Number of Units <br /> Commissar Vendin Machines <br /> Squnrn Foo age 1 with Mentonly 1 with Food Preparation I Dry Goods only <br /> Retail Market <br /> 1 Wk. 1 vehicle Type 1 Color 1 Registration A t Ucense X <br /> Food Vehicle 1 I 1 t 1 <br /> 1 Wk. 1 vehicle Type ; Color Registration p i License A <br /> Mobile Food Unit I 1 <br /> Temporary Food Facility Special Event <br /> Dates of Operation from to Dates of Operation from to <br /> HAZARDOUS WASTE FROG M {2200} <br /> I Tons gnnorntod per yonr <br /> Hazardous Waste Generator �1 <br /> Categorically authorized Categorically Exempt C ! Q� Permit by Rule <br /> Tiered Permit Facility <br /> HOUSING PROGRAM {2400 EMPLOYEE HOUSING {2700} <br /> 1 umber of Units Number or Fin ploy... Dairy 6n ployea Housing <br /> Hotel/Motel <br /> Appro.imnte Dotes of occupancy <br /> Jail or Exempt Institution to <br /> LIQUID WASTE PROGRAM 14 00} <br /> Pum er Vehicle <br /> I Registration # 1 Lic.nse 0 I Capacity I Vehicle A <br /> t t <br /> I Number nl Units <br /> Pum er Yard =1 Packa a Tre ttnent Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM 45001 <br /> Priniary Care Acute Care Skilled Nursing Large Generator <br /> Shall Generator Transfer Station Limited Hauler Veterinary Clinic <br /> 2-10 generators 11 -60 generators >50 generators <br /> Common Storage Facility <br /> RECREATIONAL HEALTH FROG AM (3600) <br /> Pool Spa Out of Service Pool/Spa Natural Bathing Area <br /> Number of Pools/Spas at Facility Pool/Spa ID p <br /> SITE MITIGATION PROGRAM { 9001 <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> I Cal EPA-RWQCB I Cal EPA-DTSC 1 US-EPA <br /> Other Lead Agency Site <br /> I NPL Site 1 Water Quality Si le 1 Other <br /> SOLID WASTE PROGRAM {44 0} <br /> Landfill Transfer Stalion Aq/Cannery A /CanneryWaste Site <br /> Number of Units <br /> CIA Landfill Site Sludge/Asti ite Compost Facility Refuse Vehicles <br /> Waste Tire Facility Process/Rec -le Facility Dunt sters >20 cu yd Number of Units <br /> VECTOR CONTROL PROGRAM 4000) <br /> Poultry Faun M.zi,m.n Nr mbar of Birds Kennel <br /> Energency,Notification for this FACILITY and/or PROGR Day Night <br /> CONTACT PERSON: JU Q \l7>°Z (ZL(:� 8 340- ZSO(D ( �j <br /> Designated Employee# Progr m Element# �� Current Status Number of Units F7C7-O wo 1 <br /> ocnivec by at. Reviewer y ate rcounong Office ate rut ar ate unit to ate <br />