Laserfiche WebLink
SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISIO MASTLAFILE REC �AFORMATION FORM{EH 00 59m• 1.ed 61941} <br /> y New EH Program/Existing Facility New EH Program/New Facility —Date <br /> SHADED SECTIONS FOR LOCAL USE,/ONLLY a 3"1 <br /> �t <br /> FACILITY ID # OO :3 o L RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size and/or Numb�t Unit.where applicable: <br /> DAIRY PROGRAM {2000} <br /> Gh.d.A Deny Grade B Deby Milk Dineen— Number of cornet....In Multi-Heatl Unit <br /> FOOD PROGRAM {1 600) <br /> Restaurant i Searle,C"Is"'ty I Saner.Foot.ge Produce Stand Ice Plant <br /> 1 or,Stereos only 1 with Food Preparation Number of Units <br /> CommissaryVerdin Machines <br /> 1 Senate Footage I with Meet Minket may I with Food P......to. 1 0,Good.only <br /> Retail Market <br /> Meke VaNPIe Type ; cost Regi.tredon/ Uoen..R <br /> Food Vehicle 1 <br /> I Make I Whole Type I Color 1 R•pletratian R 1 Unwrent 0 <br /> Mobile Food Unit I 1 I 1 1 <br /> Temporary Food Facility Special Event <br /> Data,of oneranon from ng Orion,or Onemtien from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> I To..9.ntrrowl per Ya.r <br /> Hazardous Waste Generator <br /> Tiered Permit Facility <br /> c...goticmly .mhmbetl categmiaNly Earrept CI (� ' Permit by RWe <br /> _ HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Nnnbar of Unite Nanber of BopI..... Ddry Dnployea Housing <br /> Hotel Motel <br /> Anpro.ha.le Dates of ocaaPal,gy <br /> Jail or Exempt Institution m <br /> LIQUID WASTE PROGRAM {4200} <br /> 1 Registration A I Upeme A I Capacity I Vehiele 0 <br /> Pum er Vehicle <br /> Nuenber or UMI. <br /> Pum er Yard Packs a Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primer Care Acute Care Skilled Nursin Ler a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Stora a <br /> Facilityj -to g.rwrarors t 1 -so g•n.ralar. i >so gen.ramr. <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool Spa Out of Service Pool/Spa Natural BathingArea <br /> Nunbw of Pool.Rpe. at Facility pool/spa ID 0 <br /> SITE MITIGATION PROGRAM {2900} <br /> Era ironmental Assessment UST/CAP Local Hat Waste Hat Mat Pipeline <br /> Other Lead Agency Site i Cd EPA-RWOCE 1 cal EPA-OTS. I USEPA <br /> 1 NPL Site 1 Water Quality Site 1 Other <br /> SOLID WASTE PROGRAM {4400} <br /> tC1ALa-df.II.Si.t. <br /> Transfer Station A (Canner Waste Site <br /> Sludge/Ash Site Compost Facility Refuse Vehicles Nanber of Unit. <br /> Tirailit Process/Recycle FacilityDum eters >20 cu d Number of Units <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Matter.Nu ti.r of Bird, Kennel <br /> En nuency Nonllicetlon for this FACILITY end/or PROGRAM �l D., Night <br /> CONTACT PERSON: VC7'YIOVt �l GVJ LA�"r 1 70913(o8-SI�I 1 ) <br /> Designated Employee A Proporn Eamon[#(j n z� Currant Somme Number of Unit. EPA ID/000Oq ,I Il <br /> eeave y oto ew.we y ate C•• ceounung we ateUnit Clarkem ..l 1. c•"f (G eta <br />