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SJ COUNTY PHS -ENVIRONMENTAL HEALTH 0" 'ION MASTERFILP-ECORD INFORMATION FORM (EH 00 591R.yi.w sls,u) <br /> N EH Pro, /Fa' C g F "I'ty 1New EH ProgramiNew Facility Date JI�— ,�j -e I <br /> SHADED SECTIONS FOR LOCAL <br /> y US f ONLY <br /> / <br /> FACILITY ID # l LaCf6<R,\ , - E RECORD ID # <br /> Z � � <br /> 5 e Please((�Merk the Appropriate Oescriptian and Specify Size and/or Numbof Unite where epplicebls <br /> _ DAIRY PROGRAM {2000} ,r1R 6,*,yDtf'�CIL <br /> Gud.A Dw;ry G'.de a Dairy MIG,Member f C-1.nel..n MNIilI.M UNt <br /> _ FOOD PROGRAM {1600} <br /> 1 <br /> Restaurant s..bno C.o.viw I SoaIc <br /> r.F.,. . Produce Stand e Plant <br /> ' <br /> I <br /> Commissar Ory 51.111.n•I, 1 wuVendingMachines <br /> b Fmd Repmnbon Numb.,at Urn'. <br /> I Snnnrn Fnoupa 1 wlrb Mwnr MnrXwl nNv I -uh F• P•...11don I Ory Ga. .eNv III <br /> Retail M rk t <br /> MK1 V.11d. Tyr. I Cdor I fl.O.rrntlon f U.—I <br /> [Food Vehicle <br /> ' 1 <br /> 1 Mnkw ' V.IXnIw Type ; cory R........ r U..... I <br /> Mobile Food U 't <br /> Temporary Food Facility Special Event <br /> Deu.of OasmUpn hmn to a.,..al Oper...b from 11 <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> 1 T1x a.n.,., d p.r y... <br /> Hazardous Waste Generator <br /> C.u1ab°e1W a°mndrw .V 22']x+ i e.reolbc.iw Ea.mvt i Portrait by Rl.. <br /> Tiered Permit Fac lity <br /> _ HOUSING PROGRAM {2400} _ EMPLOYEE HOUSING {2700} <br /> 1 Numbo of Unut Nunbu of 6.0i.y.es DIXry fmvl°Yew Hau.1n9 <br /> Hotel/Motel <br /> APp/n.unnrs Derx of 0°cupeney <br /> Jail ar Exempt Institution 1O <br /> _ LIQUID WASTE PROGRAM {4200} <br /> t R.o."..." P 1 Ucemw I C..—.w I WNde <br /> Pum er Vehicle <br /> ' Nunber pr UNb <br /> Pum er Yard Package Treatment Plant Chemical Toilets ' <br /> MEDICAL WASTE PROGRAM {4500} <br /> — t <br /> Primer Care Acute Care Skilled Nursing Lar a Generator <br /> Shall Generator Transfer Station Limited Hauler Veterinary Clinic <br /> 2.10 1.mrerin 1 I I -60..1....111 1 '60......mf. <br /> I 1 I <br /> Common Storage-Facility <br /> _ RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool <br /> So. Out of Service Pool/Spa Natural Sathin Area <br /> N I PIs'. F '1' Podrs'.10 A <br /> L <br /> _ SRE MITIGATION PROGRAM {2900} <br /> Environmental Assessment USTICAP Local Haz Waste Haz Mat Pi eline <br /> I Cd EPA.RW QCB I CN FPA-OTSC I US-EPA <br /> Other Lead Agency Site I1 <br /> I NPL Site I Wear OUNiw site i other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station A /Canner Waste Site <br /> Numbs a1 UNt. II <br /> CIA Landfill Site SludgelAsh Site Compost Facility Refuse Vehicles <br /> Nrmbo of U.I. <br /> Waste Tire Facility Process/Recycle Facilil :=] Dum sters >20 cu yd l <br /> VECTOR CONTROL PROGRAM {4000} <br /> - I <br /> Mwnm�m wmb..nr a..d' <br /> Poultry F Kennel <br /> 6nnrleuv Nolilinnrion I.,Ill.FACIUTY and/ar PROGRAM DM N11bt <br /> CONTACT PERSON= ( I I I <br /> Derineted Employ..> C/ Prp9rmm 9.m.nt t �� ,7 Current Sietm r Nunbsl of U." F➢A IO t eu <br /> eneived by Dete R.newea°r ets oeonan9 D ax m wt C a1X .0 I nt u <br />