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Sj COUNT.Y PHS-ENVIRONMENTAL HEALTH DIV MASTERFILE TD INFORMATION FORM(EH 00 591Reyi.ed 81941) <br /> rNew EH Program/Existing Facility New EH Program/New Facility 1 <br /> SHADED SECT/ONS FOR LOCAL USE ONLY�i ! Z2'-j2) �,/ <br /> FACILITY ID # ��S�P RECORD ID # �`pq Iq <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Unite where applicable: <br /> DAIRY PROGRAM {2000} ',UL=?''?--' <br /> Orede A Den, Crede B Deiw Milk Dispenser Number of Crudeaen In Multi-blee l Unit <br /> FOOD PROGRAM {1600} <br /> 1 Seating C.Peelw I a.....Foote Produce Stand ce Plant <br /> Restaurant <br /> I Dry Storage only I with Food Pmr,unt man Number of Unit <br /> Commissary Vending Machines <br /> 1 Srunre Footag. 1 with Meet Market only I with Food Preparation I Dry Good.only <br /> Retail Market <br /> I Make I V.Nele Type I Calor I Registration# I U.....# <br /> Food Vehicle I I I I 1 <br /> I Make I Vehicle Type I Calor I Reginmfitn # I Ucame# <br /> Mobile Food Unit I 1 I I 1 <br /> Temporary Food Facility Special Event <br /> per.°of op...firm from to Det.,f o,eration from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> I Tom a...mled per veer 'v <br /> Hazardous Waste Generator ^/ <br /> Tiered Permit Facilityi categorically emhod:ad / i cetgododry skeeter Permit by Rule <br /> _ HOUSING PROGRAM {2400} PLOYEE HOUSING {2700} <br /> I Number of Unit. Number of Employees 10.1,Emplayae blunting <br /> Hotel/Motel <br /> Approximnt Date+al Oecupeney <br /> Jail or Exempt Institution to <br /> _ LIQUID WASTE PROGRAM {4200} <br /> I <br /> Pum r Vehicle .eR.,ietiom# 1 U—mr.A 1 Cap idty I VeM1icle# <br /> e <br /> Pumper Yard Packs a Treatment Plant Chronical Toilets I <br /> Number or Unit. <br /> MEDICAL WASTE PROGRAM {4500} <br /> rrC. <br /> . CareAcute Care Skilled Nursin Lar a Generator <br /> EEi 11 <br /> Generator Transfer Station Limitedmon Stora aFacilit i z-m°°"°`a..r. tt -so....mtot. i >50,•mere.... <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> p._,._.I I spa Out of Service Pool/Spa _ Natural Bathina Area <br /> Number of PodslS as at Facility Paollbpe ID# <br /> SITE MInGAnav PROGRAM {2900} <br /> Environmental Assessment ISTICAP Local Haz Waste Haz Mat Pipeline <br /> 1 Cel EPA-RWOCB 1 Cd EPA-DTSC I US EPA <br /> Other Lead Agency Site <br /> 1 NPL bps I Water Ounlity Site I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Aa/Cannery Aa/CanneryWaste Site <br /> Number of Until <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Number of Units <br /> Waste Tire Facility Process/Recycle Facility Dum stere >20 cu yd <br /> VECTOR CONTROL PROGRAM {4000} <br /> Maximum Number of and. Kennel <br /> Poultry Farm <br /> EmergeneY Notiaeaaon for this FACILITY and/o.PROGRAM De, L} Night <br /> CONTACT PERSON: Z-(j hLpj (ZZ9 ) 6J - 7-2, <br /> Designated 6npI....# Program Dement Cone d afar Number of Units <br /> e,rtw y ata ovmv y et e...nbng me nu wt arme nt u ate <br />