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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DNIS MASTERFILE rP RD INFORMATION FORM{EH 00 5SIRayle.d 61941) <br /> N EH D g lE ' tig F 'lily New EH Progrent/New Facility I qDate J <br /> SHADED SECT/ONS FOR LOCAL USE ONLY <br /> FACILI7V ID # oo Ila -7 3RECORD ID J1 <br /> Please Mark the Appropriate Description and Specify Size endlor Number of Unit a where ppligal, <br /> _ DAIRY PROGRAM {2000} <br /> Gude A Dairy Grade B Dairy Milk Ol.p.mer Number of Container.in Multi-Heed Unit <br /> FOOD PROGRAM {1600} <br /> 1 area.,c....it, I State-Foots,. Produce Stand Ice Plant <br /> Restaurant <br /> I with Food Praperedon Number of Unit. <br /> 1 pry sm,e,e I,Is, Vendin Machines <br /> Commissar <br /> 1 anunre Footn,e 1 with Ment Merkat only <br /> I with Food Prepared.. I Dry Good.udr <br /> Retail Markel <br /> Make 1 Vel,cle Typa 1 Calor I Regletrndan a Uoen.e <br /> It <br /> Food Vehiele I 1 I 1 <br /> 1 Make 1 Vehicle Type I Color 1 R.,iededon R Ucenea i <br /> Mobile Fogd Unit 1 1 I I <br /> Temporary Food Facility :p.,..,.1.Evren.1p <br /> Dotes of op...dop D.m to Df pa°dfrom to <br /> _ HAZARDOUS WASTE PROGRAM {2200} <br /> I Tans genara[ad per yen, <br /> Hazardous Waste Generator <br /> 1 CamgodcNly authodxed Permit by Rule <br /> Tiered Permit Facility1 <br /> _ HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Number of Udts Number of Employee. Dalry Employes Nousin, <br /> Hotel/Motel <br /> Aporoximat. Date.of o.eapanoy <br /> Jail or Exempt Institution - tO <br /> _LIQUID WASTE PROGRAM {4200} <br /> I R°gietmdon k I Ucanse R 1 C....It, I Valdes It <br /> Pumper Vehicle <br /> : Nrenber of Under <br /> Pumper Yard Package Treatment Plant Chemical Toilets <br /> _MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursing Ler a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> 2-to......mr, i tt -so groaramrs >so......mr. <br /> Common Storage Faclit 1 <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool I S s Out of Service Pool/S a Natural Bathing Area <br /> Mannar of Pads/Spa.at Facility PodlSps ID P <br /> SITE MRIGATION PROGRAM {2900} <br /> Environmental Assessment USTICAP Local Haz Waste Haz Mat Pi aline <br /> 1 CN EPA-RWOCa CN EPA-DTSC 1 U6-EPA <br /> Other Lead Agency Site <br /> 1 NPL alta 1 Wnter OUMIry Site 1 Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Ao/Cannery A /CanneryWaste Site <br /> N—b.,of Units <br /> CIA Landfill Site Sludge/Ash Site Compost Facility ReTuse Vehicles <br /> Number of Uoi. <br /> Waste Tire Facility Process/Recycle Facility Dum stets >20 cu yd <br /> VECTOR CONTROL PROGRAM {4000} <br /> Meaimum Number oI Birds Kennel <br /> Poultry Farm <br /> Einer,ency Nodfie.t..for IN.FACIUTY endlor PROGRAM or, / Hirt <br /> CONTACT PERSON: Z `. fjS (20 � — 'D <br /> FDe.iqat....d Sept.,..r nolo,..a Pm...�p eem..t x Gor,.nt Number of Unita EPA IDT( <br /> are. Zz 2 3 <br /> .ease y 0.1. a.i.we y et. c.oundo,orlio. Get. nn er rte rvt t. are <br />