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4 jI Yp\ G , IT r/71 vvtW� <br /> SJ COUNTY S- VIItONMENTAL EEALTFf"D S,. MASTEAFILE R. ` INFORMATION FORM{EH 00 59meyleed 8/941} <br /> New EH Pro Bram/Existing Fecilly New EH Program/New Facility �Dete <br /> SHADED SECT/ONS FOR LOCAL USE ONLY <br /> FACILITY ID # RECORD ID #:. { � <br /> Please Mark the Appropriate Description and Specify Size end/or Number of Unita where applicable: <br /> DAIRY PROGRAM {2000} ) ') ISD Ice) <br /> Grade A Dalry Grade B Daby Milk Dinnunn r Number of CrudyWran.In Multi-Heed UNt <br /> _FOOD PROGRAM {1600) <br /> 1 Seating Capacity I Senate Four... Produce Stand Ice Plant <br /> Restaurant <br /> I Dry Storage only 1 with Ford P......donVendin Machines Nona.,of UNb <br /> Commissar <br /> I Square Footage 1 with Meet Market truly I with Food Preparation I Dry Good.only <br /> Retail Market <br /> Make VaNol <br /> ol.Type Cor i Beglebetlon p ; utters.p <br /> Fd Vehicle <br /> Make Vehicle Type ; Color Ragiefretion 9 Uo.nee p <br /> Mobile Food Unit <br /> Temporary Food Facility Special Event <br /> Data.of OPemdo. hrm to Data.of Operation from fo <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> I Tone generated par year <br /> Hazardous Waste Generator <br /> Categorically authorized Cnfegoflcally Exempt E Permit by Ro. <br /> Tiered Permit Facilit 1 1 <br /> _ HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Number of UNb Number of Employee. Der,Ernployee Housing <br /> Hotel/Motel <br /> Approxlmeb Date.of Oooup.nry <br /> Jail or Exempt Institution to <br /> _LIOUID WASTE PROGRAM {4200} <br /> I Reglevadon p I urginea 0 1 capacity I Vehicle e <br /> Pumper Vehicle <br /> 1 Number of UNt. <br /> Pumper Yard Package T tm t Plant Chemical Toilets 1 <br /> MEDICAL WASTE PROGRAM {4500} <br /> FC...G.. <br /> Acute Care Skilled Nursin Lar a Generator <br /> tor Transfer Station Lilnitad Hauler Veterinary Clinic <br /> 1 ] 10 Oi n uefrr. II-50 geoer.trb >60 generator. <br /> e a Facility1 <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> pool Sao Out of Service Pool/Spa Natural Bathina Area <br /> Number of Porislbpas at Feciliry PddlbpniD p - - <br /> SITE MMGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Hat Waste Hez Mat Pipeline <br /> 1 Cel EPA-RWOCS I Cal EPA-DTSC I US-EPA _ <br /> Other Lead Agency Site , <br /> 1 NPL Site I Water G-1hy sit. I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station A /Canner Waste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Nurr ben of uNb <br /> Number of UNb <br /> Waste Tire Facili[ Process/Recycle cle Facilit Dum stere >20 cu d <br /> VECTOR CONTROL PROGRAM {4000} <br /> Maximum Number of Birds Kennel <br /> Poultry Farm <br /> Drun,rocy Nrtiacation for thl.FACWTY anti/or PROGRAM Day Night <br /> CONTACT PERSON: <br /> Deaigneted Enployee A Pregnant Dement p 7 `� Cpne it abme NumbO,of Unit. <br /> aOBIY9 y nue .V!.W. y ate r.o.ndlg lea ale 1111 er e[e unit (e an, <br />