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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISI MASTERFILE Fir ID INFORMATION FORM EH 00 59(lt.el..d 6194)) <br /> New EH ProgramlExisting Facility <br /> N EH Program/New Facility <br /> SHADED SECTIONS FOR LOCAL USE ONLY .1 <br /> QC7D�13 ID # Yj <br /> FACILITY ID # RECORD <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Units where applicable: <br /> _ DAIRY PROGRAM {2000} <br /> Grade P Dniry Grade B DeirV <br /> Milk Diepenaar Number of Container.In Mulrl-Heed Unit <br /> _FOOD PROGRAM {1600} <br /> I snarl.,C.P.,dw I swn.e Foot.,. Produce Stand Ice Plant <br /> Restaurant - 11 <br /> I with Fond Repnrnrlon Numbar of Unit. <br /> I D.r sep.ean.lar Vending Machines <br /> Commissary <br /> 1 S.uere Fnotnga <br /> I with Most Marker may 1 with Food Prepmaaon I Dry Good.only <br /> Retail Market <br /> I M.X. I Velapin Type Color Re,buab.A Uoame A <br /> Food Vh' le <br /> I Wks I V.1d.le Te I Cdor � Redamrlan A ; Uoen.a A <br /> yp <br /> Mobile Food Unit I I I <br /> Temporary Food Facility Special Event <br /> Dnree of operation from to Date.of Opsralon from to <br /> _HAZARDOUS WASTE PROGRAM {2200} <br /> I Tone generated Per year <br /> Hazardous Waste Generator <br /> I <br /> I C....orlenll Exempt 1 Permit by flra. <br /> 1 Ceta,odoelly nmiwrlr.d 1 Y I <br /> Tiered Permit Facility <br /> _HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> 1 Number or uNts Number of Employee. Dalry Employe.Hou.ing <br /> Hotel/Motel <br /> AVproniman Dae.of O..upency <br /> Jail or Exempt Institution to <br /> _UQUID WASTE PROGRAM {4200} <br /> I RnPamtion A 1 Ucame A I Cnpncity I VeMole A <br /> Pum er Vehicle <br /> 1 Numb...f Unit. <br /> Pumper Yard Packs a Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skgled Nursing Larne Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> I 2-10 generator. 11 -60,ror. >60..nemfar. <br /> Common Storage Facilit 1 otat <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool I S , Out of Service Pool/Spa Natural Bathing Area <br /> Nuorber of Pool./Spas at Facility Podlsp.ID A <br /> _SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment USTICAP Local Haz Waste Haz Mat Pipeline <br /> I C4 EPA-MQCa 1 Cal EPA-DTSC I USEPA <br /> Other Lead Agency Site <br /> I NPL Sib I wet..QudltY Site I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Aq/Cannery A /CanneryWaste Site <br /> Nunbef of Ur:b <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Waste Tire Facilit Process/Rec cls Facility <br /> Dura stere >20 cu d wnnbar of wan <br /> VELTOR CONTROL PROGRAM {4000} <br /> UP <br /> Mastro,.Nmnber of Birds Kennel <br /> :yy F rm <br /> Ern...enpy NogOceOon for 0:a FACNITY andt.,PROGRAM Day Niyht <br /> CONTACT PERSON: I I <br /> E--,k� <br /> yee 9 Pmgtan Dement ^ Current ebtue Numbe,of Units ID A/ yyyr0.1 ^J,-Zry.In eviewe Y obi' cpowgm, wa are nit er .te ntstaffV`�r"� �T.Ja. /O <br />