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MASTFRFILE R" ID INFORMATION FORM(EH 00 691R.ele.d 8164)) <br /> Si COUNTY PHS-ENVIRONMENTAL HEALTH DNISI <br /> N EH P e IEx t 9 F ItY I �� N EH P og /N F IHV i J n_.e <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> e3Y <br /> FACILITY ID # O O 7 Z RECORD IDA <br /> Please Mark the Appropriate Description and Speoify Size end/or Nber of Unila rl�p� 1°• <br /> _DAIRY PROGRAM {2000} dd <br /> G A AO y <br /> GoodsB O ry <br /> Mk DI ear Number of CcntMmTa in Muld-Heed Unit <br /> _FOOD PROGRAM {1600} <br /> I Sees.g c...oify 1 5.....FPof.g. Produce Stand Ice Plant <br /> Restaurant I INumbs,of Unite <br /> I Dry su,.ge only 1 wab Food Premmik n Venting Machines <br /> Commissar <br /> I Sg11nIe Fo.bpa 1 whu Meet Market.NY I with Food Prepmetlon I Ory Goods oNY <br /> Retail Market <br /> 1 1 Reglsaegon a I Users.N <br /> I <br /> Make 1 Vecla Type 1 Color I 1 <br /> Food Vehicle I 1 <br /> 11 R.,uthawn R I U.....J <br /> I Minks 1 Vehicle Type 1 Colo. I 1 <br /> Mobile Food Unit <br /> FI 1 <br /> Temporary Food Facility to <br /> Event <br /> Dares of ope.ndon o-om to Dau.of Dm..run from u <br /> _HAZARDOUS WASTE PROGRAM {2200} <br /> 1 Ton.9amrwod Par yen, <br /> Hazardous Waste Generator <br /> 1 Cebgorioally euthod.ed <br /> categorically FaemDt/' ` Permit by Rile <br /> Tiered Permit FacilityI C'" <br /> _HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Number of Units Number of EnPloyees DNry EmplPyea Hominq <br /> Hotel/Motel <br /> Approximste,Dates of Da.uPenoy <br /> Jail or Exempt Institution 1O <br /> _ LIQUID WASTE PROGRAM {4200} <br /> I Reglatmb." P 1 LIuanee I 1 C.P icily 1 V.Ncle/ <br /> kti.ped, <br /> unt er Vehicle <br /> 1 Number of Units <br /> YYard Pucka a Treatment Plant=[ Chemical Toilets 1 <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursina Larne Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> 2-to Oamr.tore 11-bo generator. >so penamtm. <br /> Common Storage Facility <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> J[ <br /> pool Spa Out of Service Poof/S a Natural BathingArea <br /> Number of P.olelSpt°.f Fnpllily PadfbD.ID A <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Haz Waste Haz A Pipeline <br /> 1 C.I EPA-RW OC8 I cd EPA-DTSC I US-EPA <br /> Other Lead Agency Site <br /> 1 NPU blfe 1 Water OUMIry$ib I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Arf/CanneTV Waste Site <br /> Number of Unit. <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Retuse Vehicles <br /> Number of mdM1 <br /> Waste Tire Facilit Process/Rec cls Facilit <br /> Dum stere >20 cu yd <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Maximum Number of Birds Kennel <br /> Enemency Nmlo.agon for this FACILITY ndl.,PROGRAM Dey Night <br /> CONTACT PERSON: ( 1 1 <br /> D..ig....d Enployae• Program went Current Stat.. Number of UNuHI <br /> scene y nM1 ewawe y ate coon...ng me .b nH ar me nt to <br />