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gj Cp2 -ENVIRONIbIENTAL HEALTH DMS' MASTERFILE R' AD INFORMATION FORM{EH 00 59(Revi.ed 6194)) <br /> N <br /> EH Prograno/Exisling Facility <br /> New EH Program/New F cility Data <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> FACILITY ID # <br /> GU 7097 RECORD ID # 4 <br /> Please Mark the Appropriate Description and Specify Size end/or5bb?A0 <br /> Number pl Unks where applicable:_ DAIRY PROGRAM {2000} - _ -- a'�9 <br /> G11 <br /> .ade A Dniry <br /> trade a Uniry Milk DI..eme, Number of Cootelne,.in Melt-Heed Unit <br /> —FOOD PROGRAM {1 6001 <br /> I sa.dnC.C.poolw I Sg...to Footage Produce Stand Ice Plant <br /> Restaurant <br /> Number or UMn <br /> 1 Dry storage amr I with Food Pr.p.r.don VendingMachines <br /> commissary <br /> 1 spume Footage <br /> I with Meet Ma kat.10, 1 with Food Pr.pmatim, I Dry near.only <br /> Rettig Markel I <br /> I Make I vehicle Tree Color I Registration 0 1 Upanu i <br /> Food Vehicle I <br /> 1 I Regl.tradon A I U.... <br /> AsI <br /> 1 Make I vehicle Type Color 1 1 <br /> Mobile Food Unit I 1 <br /> Temporary Food Facility Special Event <br /> buse of OPe,.don both <br /> to Dates of Opvent from 1O <br /> _ HAZARDOUS WASTE PROGRAM {2200) <br /> 1 T.........r.led per yea, <br /> Hazardous Waste Generator 1 i recoil by Rule <br /> I CabgaricMlY eutMdxM I Catepode 1 Eaempt <br /> Tiered Permit Facility I <br /> _ HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700) <br /> ee Housing <br /> Hotel Motel <br /> I Numbs.of Uhita Number of Employees I <br /> Dniry Employ- <br /> approtimat. Dere.or occupancy <br /> Jail or Exempt Institution to <br /> _ LIQUID WASTE PROGRAM {4200? <br /> t Regisnntim. A I Unensa Y I C...6w I Vehicle A <br /> Pum er Vehicle <br /> 1 Number of Units <br /> pumper Vard Packs a Treatment Plant Chemical Toilets <br /> _MEDICAL WASTE PROGRAM {4500} <br /> Primary Care FA-uteeCraeLrSkilled Nursin Lar a Generator <br /> Small Generator sfeStation Limited Hauler Veterinary Clinic <br /> 1I >60 generator. <br /> I <br /> 2-10 genemtpr. 1 11-60'.p ernm.s I <br /> Common Storage Facility 1 <br /> _RECREATIONAL HEALTH PROGRAM (3800) <br /> Pool <br /> Spa Out of Service Pool/S a Natural Bathing Area <br /> Number of Poole/Spas <br /> at Facility Poollape In 0 <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Hat Waste Haz Mat Pipeline <br /> I C.1 EPA-RWGCB 1 C.1 EPA-DISC I USEPA <br /> Other Lead Agency Site <br /> I NPL Site 1 Water Dudity Site I Other <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station An/Cannery An/CanneryWaste Site <br /> Number of Units <br /> CIA landfill Site Sludge/Ash Site Compost Facility Refuse Vehiciea <br /> Waste Tire Facility Process/Recycle Facilit Dum stere >20 cu d Number of un11. <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Mmirman Number of Bird. Kennel <br /> Eme.gener Nod .rti.n for this FACILITY settlor PROGRAM Uey Night <br /> CONTACT PERSON: ,/� I I ( I <br /> Eg— oyee a Proguen Stomt.y 1� Cunemt alqu. Number of Uoin AFAR f0 1 �ron. ewew. y ate peomnmg I" Del. Uott 9l.ff Do'. <br />