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•?_ —_.---- — _— ____J�—___ ___ --_— __ __—_— 1:1L <br /> t SANJOA�)UIl'i COU1 t Ts l?jti'ViIZUl�C�'iLI`�7'AL IiL �LTIi I9Ei'A1Z`1'11IE1`d`i' <br /> MASTERFILE RE,C_UIW INF0101ATION FOrGI <br /> New EH T'rogram al Existiu Facility _- _ e _ ❑tlevt El Program and P1 ny Facility— <br /> FaA 0a ;204011- Program lZ,cord ID 10 <br /> Facility address 31 -33 i 7T16-1AA <br /> (Please Check the approprisle description and specify-1-1.1 number of units am pertinent information.) <br /> I DOD PROGRAM(I000) <br /> ❑Rcsiauraol: Seating Capacity Square Footage hood IIandlers Course required: YES ❑ to ❑ <br /> ❑ Commissary ❑ Dry storage only ❑ witlr Food Preparation ❑Veadiag Machines-Number of Units <br /> ❑ Retail Markel—Square footage ❑ with Meat Market only ❑ Multiple Departments ❑ Prepackaged Goods Only <br /> ❑ klobile Food Vehicle---Make Vehicle T)T.e Color <br /> Registration N License R Slicker it <br /> ❑ Mobile Food Prep Unit-make Vehicle Type Color <br /> Registration# License 9 Sticker n <br /> ❑ Temporary Food Facility--Dales of operation from to ❑ Ice I'lant <br /> ❑ Special Eveat --Dates of operation from to ❑ Produce Staad <br /> DAIRY PROGRAM(2000) <br /> ❑ Grade A Dairy ❑ Grade B Dairy ❑ Milk Dispenser—Number of Containers in MulG-Dead Unit <br /> CUPA ❑ State Facility Surcharge(7.399) <br /> HAZARDOUS WASTE PROGRAM(2200) <br /> t <br /> ❑hazardous Waste Generator-- Ton Generated Per Year ❑ Recycle/Exempt System(2299) <br /> ❑ CRT Offsite Ilandlers (2218) ❑ Silver Only(2222) ❑ Appliance Recyclers(2217) <br /> Tiered I'ermi(ling Facility --- ❑ Conditionally AutLlorized(CA) ❑ Conditionally Exempt(CE) <br /> ❑ Permit-By-Rule Fixed Unit ❑ Pcmut-lay-Mule Household Hazardous Waste <br /> ❑ ABOVEGROUND STORAGE TANK FACILITY(AST)(2390) Number of AST <br /> UNDERGROUND STORAGE TANK(US-!)PROGRAM(2300) Use IJU,4 cmd B ronnrs <br /> HOUSING PROGRAM(2400) <br /> ❑ Hotelf'Mo(el Number of Units ❑ Jail or Exempt Institution Number of Units <br /> Employe-,Ifousing(2700) Use Rmploree Ifousirf&Labor Camp Applica(iorc Form <br /> SITE MITIGATION(2900) UNDERGROUND INJECT IOIJ CONTROL(3000) <br /> ❑ EnAronmenial Assessment ❑ UST-CAP Site ❑ Local LIRV Cleanup Site. [INPL/SEP Clezaup Site ElUIC Site <br /> ElAbandoned IM'Site El non-NPLISEP Cleanup Site 11RlN,QCB Cleanup Site ❑ Vila ter Quslily Remediation Site <br /> RECREATIONAL HEALTH PROGRAM(3600) <br /> Number of Pools/Spas at Facility ❑ Pool ❑ Spa ❑ Out of Scr�ice Pool/Spa ❑ Natural Bathing Area <br /> VECTOR CONTROL PROGRAMA(4000) <br /> ❑ Poultry Farm h4aximum number of birds ❑ Kennel <br /> TATTOO BODY PIERCING,PERMAtIENT COSMETIC PROGRAM(4100) <br /> ❑ Tattooing(4121) ❑ Body Piercing(4120) ❑ Perruauent Cosmetics(4122) <br /> LIQUID WASTE PROGRAM(4200) <br /> ❑ Pumper Vehicle-Registration 4 License tl Capacity Vehicle t7 <br /> ❑ Pumper Pard ❑ Package Treatment Plant- ❑ Chemical Toilets P,rumber of Units <br /> SOLID ilASTE PROGRAM(4400) <br /> ❑., Landfill El Transfer Station El Ag/Csnncry Waste Site ❑ Sludge/As(i Site <br /> W\Vaste Tire Facility ❑ Compost Facility ❑ Process/Recycle Facility ❑ CIA Landfill Site <br /> ❑ Refuse Vehicles-1 lumber of Units ❑ Dumpsters>7.0 cu yd —Number of Units ❑ Farm/luach Clcaoup Site <br /> MEDICAL WASTE PROGRAM(4500) <br /> ❑ Primary Care ❑ Acute Care ❑ Skilled Hursing ❑ Large Generator ❑ Small Generator ❑ Limited llauler <br /> ❑ Transfer Station ❑ Veterinary Clinic ❑ Common Storage Facility-----rl 2- 10--❑ 11 -60-- ❑ GO generators <br /> PUBLIC WATER SYS i EN PROGRAM(4600) Use 1 It;S.FHD.1v-02-003 Bfire 1prliia(ion Furnr <br /> EMERGE-HCY NOTIFICATION FORT IHS FACILITY orf AND10R r-R0GPAI'A <br /> CONTACT PFI;SON Day PIS Nik,ht Ph <br /> I'i:UC�antlaatniGh7 �1�0 <br /> VEE� — ❑ Su1-ch3rgel`EE ❑ L�tl,cri't: ----- <br /> tysre(-rr.,R,Y _04cla_ I'cl-P.n�'1rALtD -- to _ 1T-ovd Handlcr --_ <br /> CI xhK 1P,i0Uyr1',:lts ?•?lc-- <br /> I <br /> -0 Ca: -_- <br />