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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DNISI MASTERFILE lR'r RD INFORMATION FORM EH 00 591Revi.ed 61941) <br /> ill New EH Program/Existing Facility New EH Program/New Facility I Date l I <br /> SHADED SECT/ONS FOR LOCAL USE ONLY -7 3 3'J a� 3 <br /> FFFACILITY ID # RECORD ID At g4 D 1' <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Units where appli..bT.. <br /> DAIRY PROGRAM {2000) J. - >;.,. — r: :> , ' <br /> Gorda A Deity Gude B Dairy Milk Dl...mro Number of C.MAOan In Muld-Heed Uatl <br /> FOOD PROGRAM (7600) <br /> 1 Senting Cnp.ciry 1 S.u..e F..,.,. <br /> Restaurant Produce Stand Ice Plant <br /> I Dry Store,.Only I with Food Prepmation Number of UNI. <br /> Commissar Vendin Machines <br /> I S.nara Footeya I with Ms.t Merkat only I win,Food P......don I Dry Good.amr <br /> Retail Market <br /> 1 <br /> Food Vehicle Make i Wrote Type 1 Color i Ragl.netlon♦ r U.....a <br /> I 1 I 1 I <br /> i Mak. i Vehicle Type I Calor i Raa.tratlon ♦ i uawW.l <br /> Mobile Food Unit 1 1 1 I I <br /> Temporary Food Facility [o.. <br /> l Event <br /> re <br /> 0ata.of opaaon from to Opeutlpn from to <br /> HAZARDOUS WASTE PROGRAM (2200) <br /> Hazardous Waste Generator i Ton.g--Ird par r.a. <br /> Tiered Permit Facility <br /> C.baorloNiy unl o bed Cebgodcally Ezampt Panni,by Rate <br /> _ HOUSING PROGRAM (2400) EMPLOYEE HOUSING {2700) <br /> 1 Numbar or units -bar of Employee. Dtlry 6nploy..Ibusinp <br /> Hotel/Motel <br /> App...Imala Date.of O..uPermy <br /> Jail or Exempt Institution to <br /> _LIQUID WASTE PROGRAM (4200) <br /> I R.a.tratan N 1 u.....R I C.P.aty I valid.f <br /> Pum er Vehicle <br /> Pumper Yard Package Treatment Plant Chemical Toilets I Number of unt. <br /> MEDICAL WASTE PROGRAM (4500) <br /> Primer Care Acute Care Skilled Nursing Larrue Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Stora aFacilit t-10 ga.uretors 11 -60 gamrebn >so...sato,. <br /> RECREATIONAL HEALTH PROGRAM (3600) <br /> Pool <br /> Spa Out of Service Pool/S a Natural Bathin Aree <br /> Number of Paols/Spas et Facility Pod/Spa I0 0 <br /> SrTE MmGATION PROGRAM {2900) <br /> Environmental Assessment UST/CAP Local Hat Waste Hat Mat Pipeline <br /> 1 Cd EPA-RWGCB I Cd EPA-DTSC I US-EPA <br /> Other Lead Agency Site <br /> 1 NPL Site I Water Gudiry Site 1 Other <br /> SOLID WASTE PROGRAM {4400) <br /> Landfill Transfer Station Ag/Cannery Ag/CanneryWaste Site <br /> Numb.,of utile <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Waste Tire Facility Process/Recycle Facility Dum stere >20 cu yd Nambar or unit. <br /> VECTOR CONTROL PROGRAM (4000) <br /> Mrt.imom Number of Birds Kennel <br /> Poultry Farm <br /> Emergency Nodfieatlon for tbi.FACIUTY.rd or PROGRAM Day Night <br /> CONTACT PERSON: I ) <br /> D..ign.lad Employe.9 N.".Sierra a Current Status Number Of Univ <br /> Ro,—N.d by Data FWv,.sotd by Date Acoornfliig office eta Illl ar ntaUNI-97.0— me <br />