Laserfiche WebLink
S,F COUNTY PHS-ENVIRONMENTAL HEALTH DR/ISIt MASTERFILE RE D INFORMATION FORM (EH 00 59(11eyl..d 6154)) <br /> New E'Program/Existing F Tay New EH Program/New Facilhy Date <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> FACILITY ID # RECORDID # <br /> Please Mark the Appropriate Diption and Specify SE..and/of Number of Units where applicable: <br /> escr <br /> _DAIRY PROGRAM {2000) ") —t7t l t0 el ) " <br /> Grade A Oairy Grade R Dairy Milk Di...... Number of Container.In Mdd-Heed Unit <br /> FOOD PROGRAM {1600} <br /> I S.aflng Cepaplty I Sloss Fgotave Produce Stand Ice Plant <br /> Restaurant <br /> 1 Dry Storage only I with Food N.P.ra6.n Number of Units <br /> ERetailiMairkel <br /> Vendin Machines <br /> I Square Fee,... I with Meet M.,ket only I with Food Preperetlon I Dry Good.only <br /> I Make I Vehicle TYpe 1 Color I Registretlon A Uvaoss f <br /> Food Vehicle 1 1 1 1 <br /> I Make 1 Vehicle Type 1 Cdor f Relished..A License A <br /> Mobile Food Unit 1 I I 1 <br /> Temporary Food Facility Specie) Event <br /> Date.of Operetlgn horn to Dates or Op.r.tlon from to <br /> _HAZARDOUS WASTE PROGRAM {2200) <br /> I Too.g.n.r.ted per vs.r <br /> Hazardous Waste Generator <br /> Cetegaeically authorized C.1.20'. Ily am ' Permit by Rnie <br /> H] <br /> Tiered Permit Facility <br /> FJai.11 <br /> HOUSING PROGRAM {2400) EMPLOYEE HOUSING 00} <br /> I Number of Units Number of Dole.,... Unify Employee fbueingMotel <br /> 11 Approxhonte Delos of occupancy Exempt Institution to <br /> LJQUID WASTE PROGRAM 14200? <br /> I Regletra6on A I Upeme A 1 C.P.Wty I Voted.A <br /> Pumper Vehicle <br /> jNumber or Unite <br /> Pum er Yard Packs Treatment Plant Chemical Toilets <br /> _MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursing Lotus Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> i 2-10 generator. 11 -6o per.r.tpr. >60 generator. <br /> Common Storage Facilit I <br /> _RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool <br /> SUB Out of Service Pool/S n Natural Bathin Area <br /> Number of P.W./Spee M Facility PoallSpe ID A <br /> _SITE MITIGATION PROGRAM (2900) <br /> Environmental Assessment i UST/CAP Local Haz Waste Haz Mat Pipeline <br /> 1 Cel EPA-RWQCa 1 Cnl EPA-DTSC I USEPA <br /> Other Lead Agency Site <br /> I NPL Site i Water Queliry Slte I Othef <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station AEF/Cannery Waste Site <br /> Number of Unit. <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Number of Unib <br /> Waste Tire Facility Process/Recycle FacilityDunt stere >20 cu d <br /> _VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Maeimun Number of Girds Kennel <br /> Dnergency Nogfl..d.n for this FACILITY end/or PROGRAM Day Night <br /> CONTACT PERSON: ( ) <br /> Deaignaled Employee AProg1 n Re nent# Currant Sint... Numbei of Unite FPA ID•j ' •'➢�! + { <br /> ecewer y <br /> nIe ew wo< y me Dote nit er ata unit StanA ate <br />