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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISI MASTFRFILE RF 'D INFORMATION FORM(EH 00 59(rte.i.ed 619.1} <br /> New EH Program/Existing Facility E: New EH Program/New Facility I \�Dete <br /> SHADED SECT/ONS FOR LOCAL USE <br /> ONLY <br /> FF FACILITY ID # RECORD ID # 50 7D l() <br /> Please Mark the Appropriate Description and SpecifySize end/or Number of Unite where applicable: <br /> DAIRY PROGRAM {2000) , I — 07Qti <br /> [7-=A Dairy Grade a Dairy Milk mepena.. Number of Contelmn to Mula-Hoed UNt <br /> FOOD PROGRAM {1 6001 <br /> I s.nHn,C.P.dw I S Pure Footage <br /> Restaurant Produce Stand Ice Plant <br /> I Dry stare,.on, I with Food Parasol.., Number of Units <br /> FC0--M--,,1y I 1 11 Vendina Machines <br /> I <br /> Ketal Market Seuere F.,.,. I with Meet Market only I with Food P......do. I Dry GooM only <br /> Food Vehicle <br /> M.ke I V.N.I.Type I Color I lh,itthro or e I U.....# <br /> I I 1 I I <br /> Mobile Food Unit <br /> Mak. I Vehicle Tyro I Color I Ro,i.bntion I I Uoen..# <br /> i I I r I <br /> Temporary Food Facility Special Event <br /> Do,..of orators.. tram to Det..or Operafion from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> Hazardous Waste Generator I Tom,e.r.,.d per year <br /> Tiered Permit Facility <br /> cete,odeNly enthorired Cnrngodenlly Exempt Permit by R i. <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> Hotel/Motel I Number of Units Number or Est.,... Dnlry Employe,Houein, <br /> App...bnse Oct..r1 Oocuponay <br /> Jail or Exempt Institution it <br /> LIODID WASTE PROGRAM {4200} <br /> Pum er Vehicle 1 S.,t.o^non # 1 ua....# I capacity I v.Nde a <br /> Pumper Yard Package Treatment Plant Chemical Toilets I Nrrnb^r,of Ualta <br /> MEDICAL WASTE PROGRAM (4500) <br /> Primary Care Acute Care Skilled Nursin Laine Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facilityi 2-I0 genomtors I -60 generators >60,,;n...or. <br /> RECREATIONAL HEALTH PROGRAM {3600) <br /> Pool <br /> spa Out of Service Pool/Spa Natural Bathing Area <br /> Number al Pools/Spee at Froth, Pod/Spa ID a <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Hat Waste Hat Mat Pipeline <br /> Other Lead Agency Site I chi EPA-Rwoce I Cd EPA-DISC i US-EPA <br /> 1 NPL site i Water G.shr site I Other <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station AgICannery Waste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Number of Units <br /> Waste Tire Facility Process/Recycle Facility Dum eters >20 cu yd Number of unite <br /> VECTOR CONTROL PROGRAM {4000) <br /> Pou1Gy Farm M.dorun Number of Bird. Kennel <br /> Energ.nay Notification for this FACILITY and/or PROGRAM Do, NI,ht <br /> CONTACT PERSON: <br /> E <br /> Employee a Pro grsn Eement# Cnneat Statue Number of Unite EPA 10# <br /> �C C. �.�KaGlll.'?Z3` <br /> y roc Reviewed by Date Aarx,Moia, Offi.o Do. Urit Chult rhai—TUR-tsualeta <br />