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1 os-:5, Main 5f- <br /> SJ CQUNTY P.S-ENVIRONMENTAL HEALTH DMS' MASTERFILE R' 'ID INFORMATION FORM {EH 00 69111. lhr d 81941} <br /> 11 New EH Program/Existing Facility New EH ProgramlNew Facility <br /> SHADED SECT/ONS FOR LOCAL USE ONLY 993/-3 <br /> FACILITY ID # OOD SSL/. 11 RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size end/or Number of Units where applicable: <br /> DAIRY PROGRAM (2000) Pd l '5— '�� ,,' , 11 <br /> Grade A DeirY Grade B Odw Milk 01......I Number of Contelears in Muld-Hoed Unit <br /> FOOD PROGRAM {1600) <br /> Restaurant I Seeding cope=Iry 1 6.....Feeling. Produce Stand Ice Plant <br /> ' <br /> I Dry 9mrege one <br /> 1 with Food Neoprene" Number of Unit. <br /> Commissary I Vendinit Machines <br /> 1 Sauare Footpg. 1 with Meat Marker on, I with Food Preparetlon I Dry Good..0, <br /> Retail Market <br /> Make I Vehicle Type 1 Color I Roglstrad.n A 1 U..me A <br /> Food Vehicle 1 1 I I I <br /> 1 Mnk• 1 VeNale Type 1 Calor 1 attained.. N 1 U.•n.e A <br /> Mobile Food Unit I 1 I 1 I <br /> Temporary Food Facility Special Event <br /> Det•.of Oper.tlon from to Dales of operate. from to <br /> HAZARDOUS WASTE PROGRAM {2200) <br /> I Tone generated per year _ <br /> Hazardous Waste Generator <br /> Tiered Permit Facility <br /> categorically authorized cabgoricelly Exempt Permit by Rule <br /> HOUSING PROGRAM (2400) EMPLOYEE HOUSING {2700} <br /> 1 Nuber of Unlb .Number of Emplayeas Dairy 6n,1....Housing <br /> HotellMotel m <br /> Appmaimpm Dates of ope.ppnoy <br /> Jail or Exempt Institution to <br /> _ LIQUID WASTE PROGRAM (4200) <br /> Pum er Vehicle 1 R•gbtratlon A 1 Up...A 1 c.'enity 1 Vanes <br /> Pumper Yard Package Treatment Plant Chemical Toilets Number of Units1 <br /> MEDICAL WASTE PROGRAM {4500} <br /> Prima' Care Acute Care Skilled NursingLar a Generator <br /> Shall Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facility0-TO generators 11 -SO gan.r.tor. >60 generate. <br /> RECREATIONAL HEALTH PROGRAM (3600) <br /> Pool spa Out of Service Pool/Spa Natural Bathing Area <br /> Number of Pools/Spee at Facility Pool/Spa to it <br /> SITE MmGATION PROGRAM {2900} <br /> [ffE�nvirwmentalssessment USTICAP Local Haz WasteHaz Mat Pi aline <br /> I Cel EPA.RWOCB 1 Cal EPA-DTSC 1 US-EPA <br /> cy Site I 1 <br /> 1 NPL Site 1 Weter Oneiry Site 1 Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Ag/Cannery Waste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Number o1 unit. <br /> Waste Tire Facility Process/Recycle Facility Dum stere >20 cu yd Nunber of Unit. <br /> VECTOR CONTROL PROGRAM (4000) <br /> PoulDy Farm Mesimum Number of Bird. Kennel <br /> 6n•rgancy Notignetoe for lids FACILITY mtdlor PROGRAM Ony NIpM <br /> CONTACT PERSON: ( ) ( ) <br /> Designated EmployeP.....n Dment A Currat Stat. Number of Units EPA 10 A <br /> Z`3Z <br /> aeeryy ala ,i..e yData Accounting a atet.nae <br />