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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DNISr MASTERFILE RI 9D INFORMATION FORM{EH 00 69(neyi.ad 0/941} <br /> New EH ProgrenrlExisting Facility New EH Program/New Facility (\� Data <br /> SHADED SECTIONS FOR LOCAL USE ONLY v133 <br /> FACILITY ID # -T-00-4 cl RECORD ID # / <br /> Please Mark the Appropriate Description and Specify Size end/or Number of Units where applicable: <br /> _ DAIRY PROGRAM {2000) - - <br /> Orede A Dairy Grade B DMry Mllk Diane.... Number of Contnine..In Muhi-Heed Unit <br /> FOOD PROGRAM {1600) <br /> Restaurant I S..1.,Capacity I Saner.Footage produce Stand Ice Plant <br /> ' <br /> Commissar <br /> I Dry 51°1.1..14,qy 1 with Food Prepa..loMachines <br /> n Number or Unit. <br /> Vendin <br /> 1 Serene Foots.. I with Meat Market only I with Food Preparation I Dry used.only <br /> Retail Market <br /> I Make 1 VeN.le Type 1 Col.r 1 Rep mnlon • I UC.".. <br /> Food Vehicle I I 1 1 I <br /> I Mnke i Vehicle Type Color Ra.i.,beke. A ; Uoen.e A <br /> Mobile Food Unit I <br /> Temporary Food Facility Special Event <br /> Ome.of Oper.dpn from to I Dare.of Overedon from to <br /> _HAZARDOUS WASTE PROGRAM (2200) <br /> gapy <br /> Hazardous Waste Generator I Ton. e.r.l.d er ear Tiered Permit FACIIIL j Caregodcelly euthpdzed Categodeally Exempt Gl�; O-T CO : <br /> Permit by Red. <br /> HOUSING PROGRAM (2400) EMPLOYEE HOUSING (2700) �� <br /> 1 Number of Unie Mnnber of EnploYeea Dairy Employee Hou.ing <br /> Hotel/Motel <br /> ApOroalmnte Dale.of Oooup.my, <br /> Jed or Exempt Institution tO <br /> IJOUID WASTE PROGRAM {42001 <br /> 1 Repiatrafion A I Uce.we A 1 Cepeplry I Vehicle A <br /> Pumper Vehicle <br /> 1 Number of Unite <br /> Pum er Yard Packs a Treatment Plant Chemical Toilets 1 <br /> MEDICAL WASTE PROGRAM 145001 <br /> IFPr.m.,y Care I Acute Care Skilled Nursing Lar a Generator <br /> Small Generator I Transfer Station Limited Hauler I Veterinary Clinic <br /> Common Storage Facility <br /> t'10......to,. 11 -60 generemrs >60.......bo. <br /> RECREATIONAL HEALTH PROGRAM {36001 <br /> Pool --Fs-r,. I Out of Service Pool/Spa Natural Bathing Area <br /> Number of Poole/Sp.s at Facility pooifsp.10 A <br /> SITE MITIGATION PROGRAM (2900) <br /> Environmental Assessment I UST/CAP Local Hat Waste Haz Mat Pipeline <br /> Other Lead Agency Site 1 CA EPA-RWOCB I CA EPA-VTSC I USEPA <br /> 1 NPL Site 1 W.ter Quell,Site I Orion <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station A /Canner Waste Site <br /> Number or Unit. <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Waste Tire Facility Process/Recycle Facilit Dum stere >20 cu yd Number of Unite <br /> VECTOR CONTROL PROGRAM (4000) <br /> Poultry Farm Maximo.Number of Bird. Kennel <br /> Emergency NoYfication for this FACILITY endfor PROGRAM Day Night <br /> CONTACT PERSON: 4 r tn, .k3 vt_*j Cc— 12091 `9.44 — 2ZD� 1 1 <br /> Ebesigmtedee A Plggre„S mm A 22as Current Stnlw Number or Unils EPA ID E/\„ AnS�me .viewae y nis <br /> caounUnq eeD <br /> e <br /> r <br /> e nit Clerk me I 1.00 W .n. <br />