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sic PHS-ENVIRONMENTAL HEALTH DNISI MASTERFILE RF 7D INFORMATION FORM {EH 00 59(tuyt+.d areal) <br /> JENew EH Program/Etlisting Faciihy New EH Program/New Facility r Date <br /> SHADED SECT/ONS FOR LOCAL USE ONLY <br /> FACILITY ID # DU � 9`�1 <br /> t RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Unita where applicahle: <br /> DAIRY PROGRAM {2000} <br /> Grade A Dairy Grade B Ddry Milk Dimemer Number of Containers In MultiReadUnit <br /> FOOD PROGRAM (7600) <br /> 1 Sontag C.P.rhy 1 6qunre Earn... <br /> Restaurant Produce Stand Ice Plant <br /> 1 DV btomlp only 1 whh Rood Reperatlon Number of Unit, <br /> Commissar Vendirm Machines <br /> Retail Market I Square Footage I with Meat Merkel only I with Food P-Inala. I Dry Goods ani, <br /> t Make I V.h ie Type I Color I Repinratlon A t Ucanee A <br /> Food Vehicle i I I I 1 <br /> Meke 1 VeNds Type I Color I R.&c.d.a Jr l Ucansa A <br /> Mobile Food Unit I 1 I I 1 <br /> Temporary Food Facility Special Event <br /> Date.of Opa.d.. born to Date.of opemNon from to <br /> HAZARDOUS WASTE PROGRAM {2200) _q <br /> ap <br /> Hazardous Waste Generator 1 Ton. .rotor" a.Y.ar , O <br /> Tiered Permit Fa cilit i C.tagan.alp antunh.d i car...rro 1 pt �,� Permit by Rule <br /> HOUSING PROGRAM {2400) EMPLOYEE HOUSING (27001 <br /> I Number o/Units ��—bokaaEanploysesDart F nployes HousingHotel/Motelu <br /> Jail or Exempt Institution Date+of Oocup.00y to <br /> Liam WASTE PROGRAM {4200) <br /> 1 Reyl.tmtlon A 1 Ucec'.A I capsdty I Vehicle I <br /> Pum er Vehicle <br /> j <br /> Pumper Yard Package Treatment Plant Chemical Toilets Number of Unite <br /> MEDICAL WASTE PROGRAM {4500) <br /> Primary Care Acute Care Skilled Nursing Lar a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facilityi 2.10......to'. t t -so aennamr. >so paneramr. <br /> RECREATIONAL HEALTH PROGRAM (3600) <br /> Pool I Spa Out of Service Pool/Spa Natural Balhina Area <br /> Hatcher of PoolslSpas at Facility Poof%ps ID R <br /> SITE MITIGATION PROGRAM (2900) <br /> Environmental Assessment UST/CAP Local Haz Waste Hat Mat Pi aline <br /> Other Lead Agency Site I Cel EPA-RWGCB I Cal EPA-Disc I Us-EPA <br /> 1 NPL Site 1 Wau.Gu.law site I olMr <br /> SOLID WASTE PROGRAM {4400) <br /> Landfill Transfer Station Aa/Cannery Aa/CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Ntnnbar of Unit. <br /> Waste The Facilit Process/Rec cls Facility Dum stere >20 cu d Natnn.r ar mat. <br /> VECTOR CONTROL PROGRAM {4000) <br /> Pouwy Farm Meaimum Number of gird. Kennel <br /> Emeraarcy Notificath n for this FACIDTY andfa.PROGRAM Day MPht <br /> CONTACT PERSON: ( ) ( ) <br /> Da.ianat.d Empiaya.A Rogre -!L; ccloot Son.. Number of Unit+ FAA 10 i El <br /> eaewe y ate eviewe y eto caaun in me ate nq .r ata nt to <br />