Laserfiche WebLink
SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISI MASTERFILE Rr 4D INFORMATION FORM{EH 00 591R.-..d sisal} <br /> New EHPr mm/Existing Facility New EH ProgramlNew Facility 1 Date <br /> SHADED SECTIONS FOR LOCAL USE ONLY Ag 3V/! <br /> FE FACILITY 1D # <br /> 007(n£S G RECORD 1D # 57)bL <br /> Please Mark the Appropriate Description and Specify Size end/or Number of Unite where opplioe,W <br /> DAIRY PROGRAM {2000} aSr°, 1 <br /> Grad•A OeirY scale 6 Dairy Milk More...r Nomb.r of Comeln•s in Mind-Need Unit <br /> FOOD PROGRAM {1 6001 <br /> 1 Seaga,Capacity I Sponte Footapa <br /> Restaurant Produce Stand Ice Plant <br /> I Dr,Storey ody I with Food P®Porndmr Nunber of Units VdinenMachines <br /> 1 Sauer.Fan... I with Meat Market rally 1 with Food Preparation I Dry Goods any <br /> Retail Market <br /> 1 Make t Vehicle Typo I Cdor I Registration e I Uo•ms J <br /> Food Vehicle 1 1 1 I 1 <br /> Make 1 Vehicle Type I Co., I Regi.trd i.a • Ucenas l <br /> Mobile Food Unit I I I 1 <br /> =Te-p-r.'r.yd Faclity Special Event from to Del.°of Op°ratlon from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> Hazardous Waste Generator 1 Tor,."..rated or rear <br /> Tiered Permit Facilityj C.1e"anally emhod..d cam"rladh Exemat Permit by ad. <br /> _ HOUSING PROGRAM {2400} EMPLOYEE: HOUSING {2700} <br /> 1 Norther of Units Number or Employee• Del,Employee Houalnp <br /> Hotel/Motel <br /> Approximate Dates of Occupancy <br /> Jail or Exempt Institution t° <br /> LJOUIO WASTE PROGRAM (4200? <br /> 1 thamocoRnt 1 I Ucena.a I C...aw I Vehicle I <br /> Pumper Vehicle <br /> Nunber or Unk. <br /> Pumper Yard package Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled NursingLar a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facilitya°"°'atpr• t t -so......tors <br /> RECREATIONAL HEALTH PROGRAM (3800) <br /> Pool spa Out of Service Pool/Spa Natural Bathing Area <br /> Number of Pool.lapea at Facility POdISps IDS <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment I UST/CAP Local Haz Waste Haz Mat Pi eline <br /> Other lead Agency Site 1 Cal EPA-RWGCa 1 Cal EPA-DISC 1 USEPA <br /> 1 NPL Sib 1 Weter Quality Site 1 Other <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station Ag/Cannery Ag/CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Faclity Refuse Vehicles Number of Alone <br /> Waste Tire Facility Process/Recycle Facility —diDum eters >20 cu yd Nunhar or Unt. <br /> VECTOR CONTROL PROGRAM {4000) <br /> Maximum Nunber of girds Kennel <br /> Poultry Farm <br /> Energen., Notiacetion for this FACIUTY end/or PROGRAM Day Night <br /> CONTACT PERSON_ 1 ) 1 1 <br /> Da•iow,al Employee A Progrnn a currant status Nunber of Unite EPA ID D Tq- <br /> VA <br /> w eb av ewe y ate caoadiu, io° at. nt ar mne t to <br />