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SJ OOUNTYYHS-ENVIRONMENTAL HEALTH DIVIS MASTERFILE W ID INFORMATION FORM(EH 00 591Ra1.e0 6/941) <br /> New EH Program/Existing Facility New EH Program/New Facility Date <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> FACILITY ID # <br /> 0005/q . RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Unite where applicable: <br /> DAIRY PROGRAM {20001 ' <br /> Grade A Dairy Gude B Dairy Mllk Dlepenear Nnmb.,of Container.In M06-14ead Unit <br /> FOOD PROGRAM {16001 <br /> 1 seed.,C.,..iw 1 Square Footage Produce Stand Ice Plant <br /> Restaurant <br /> 1 with Food P-0.1.0m Nunbar of Urdu <br /> 1 DIV sb,ege gnir Verdin Machines <br /> Commissary I <br /> i S9ema Fast... 1 with Meet Market only 1 w10 Food Pfap—mm 1 Ory Good.amv <br /> Retail Ma ket <br /> I MN,. I V.Wd.Type Colo, R.'a" lm,l Ucenea a <br /> Food Vehicle I 1 <br /> I Make I Vehlde Type 1 Calor v <br /> I Reglendon a Umn.e a <br /> Mobile Food Unit 1 I 1 <br /> Temporary Food Facility Special Event <br /> notes of Operation fmat to Data.of Oper.tion from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> 1 Ton.,e.erated per year <br /> Hazardous Waste Generator <br /> 1 categorically sudmd:ed CategodcNlY Exempt (� Permit by Rule <br /> Tiered Permit Facility 1 <br /> _ HOUSING PROGRAM (2400) EMPLOYEE HOUSING {2700} <br /> 1 Ntmbe,of UN[. Nwnber of E ,1..... DA,imPloyee HOu.I., <br /> Hotel/Motel <br /> Approximate Deter nl oc°upenny <br /> Jail or Exempt Institution to <br /> LIQUID WASTE PROGRAM {4200} <br /> I Rad.tmo.. # I Unenea a I Capacity I Vallols a <br /> Pumper Vehicle <br /> Number of Unite <br /> Pumper Yard Package Treatment Plant Chemical Toilets <br /> _ MEDICAL WASTE PROGRAM {4500) <br /> Primary Care Acute Care Skilled Nursing Larne Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> 2-10 generator. 11-60......tore >60 peneretora <br /> Common Storage Facilit 1 <br /> _RECREATIONAL HEALTH PROGRAM {3600} <br /> Paol <br /> Son Out of Service Pool/Spa Natural Bathing Area <br /> Number of POOh/Spa.at Facility PONISPS 10 a <br /> _ SITE MITIGATION PROGRAM (2900) <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Met Pipeline <br /> 1 Cel EPA-RWQCB 1 CA EPA-DTSC I US-EPA <br /> Other Lead Agency Site <br /> 1 NPL Site I Webr Quellty Sib 1 Other <br /> SOLID WASTE PROGRAM {4400) <br /> Landfill Transfer Station An/Cannery An/CanneryWaste Site <br /> Number of Unib <br /> CIA Landfill Site Sludge/Ash Site Compost Facility use Vehicles <br /> Nmnbar of Unit. <br /> Waste Tire Facility Process/Roc cls Facilit Dura pstere 120 cu yd <br /> VECTOR CONTROL PROGRAM {4000} <br /> PoulMrotlam n Nunber of gird. Kennel <br /> try Farm <br /> Emergency Notification for this FACILITY and/or PROGRAM Day Night <br /> CONTACT PERSON: ( } <br /> Dawgsated Fmployaa Jr Program Be t Current Stntw - Number of Unib EP�y4 i dye lO'77 <br /> every. Y me ewewer Y <br /> me .Door..., rve ate Enit er me rvt a L^•r`/ are <br />