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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DAISMASTERFILE Rrr 4D INFORMATION FORM{EH 00 591Aeyb.d 8/941} <br /> mo�N EH P g /Ex' tig F 'lity N EH P g /N Facility <br /> I Date " '� <br /> SHADED SECTIONS FOR LOCAL USE ONLY 3 <br /> FACILITY ID # RECORD 1D # �� '�� 15;2�1/71/ <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Units where applicable: <br /> _DAIRY PROGRAM {2000} � - <br /> G�nde A Dairy Grade 9 Dairy Milk Dbpen..r Number of Costal ...In M.Wtl Ahr.d Unit <br /> FOOD PROGRAM {1800) <br /> I Sinning capacity 1 $,.ar.F..,.,. Produce Stand Ice Plant <br /> Restaurant <br /> I Dr"Store,e i 1 with Food P-i nmtimr Nmnber al Units <br /> Day n� y Vendin Machines <br /> (:Olnln1668r l <br /> I Sq are Foatege 1 with Ment Market only 1 with Food Preparation I Dry Good.oMy <br /> Retail Market <br /> 1 Make Vehicle Type i Color Regl.trnaon Or Urnon.R <br /> Food Vehicle 1 <br /> Make 1 V.Nole Type 1 Co., 1 Relpetra not a ; Uaanse i <br /> Mohile Food Unit 1 1 I <br /> Temporary Food Facility Special Event <br /> Dates of Opetetlon from to Dates of Operation frontto <br /> _HAZARDOUS WASTE PROGRAM {2200) <br /> I Tons generated per year <br /> 1[:H:.zardous Waste Generator <br /> 1 Categorically nuthodged Categorically Eaempt 1 Permit by Rule <br /> Tiered Permit Facilit 1 1 <br /> _ HOUSING PROGRAM (2400) EM YEE HOUSING {2700) <br /> 1 Number of Unit. Number o1 Enplcyee. Dery Empi........In, <br /> Hotel Motel <br /> APPro.imnt. Date.01 occapancy <br /> Jail or Exempt Institution to <br /> _ LIQUID WASTE PROGRAM (4200) <br /> I Regb nation I 1 Ucene.A 1 Capacity 1 Vehiple a <br /> P per Veh' le <br /> Number of Unit <br /> Pumper V rd Package Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursing Large Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> z-/0 garen.tor° I I -so g.aernlor. >so g.neramr. <br /> Common Storage Facilityi <br /> RECREATIONAL HEALTH PROGRAM (3800) <br /> Pool S a Out of Service Pool/S a Natural Bathing Area <br /> Number o!Poob/Spec'st Facility Pool/Spa ID i <br /> SITE MITIGATION PROGRAM (2900) <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> I Cd EPA-RWOCB 1 CA EPA-DTSC 1 USEPA <br /> Other Lead Agency Site <br /> 1 NPL Site I Water Q.allw Sita I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Aa/Cannery Waste Site <br /> theories,of Units <br /> Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Waste Tire Facgit Process/Recycle Facility <br /> Dum stere >20 cu yd Number of Unit <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Mnnhmnn Nunbar of Birds Kennel <br /> Emergency Wfifited..for this FACILITY eM/on PROGRAM Day Night <br /> CONTACT PERSON: K' PPrI r 5 ( � <br /> Oeaignetad Enployee A Program earn n M Current Stat. /.,t Number of UMn EFA ID At G <br /> t J <br /> O D.A.finBRaf.9V0 y y ate gI Data n <br />