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SJ COUNTY PHS • ENVIRONMENTAL HEALTH DWISION MASTERFII F RECORD INFORMATION FORM (EH 00 591R—i—d 6/941} <br />IFNew EH Program/FAisting Facility New EH ProgramlNew Facility Dote l I Lp(, �- <br />SHADED SECTIONS FOR LOCAL USE ONLY <br />DAIRY PROGRAM <br />{2000} <br />Gard. A Dairy - <br />Grade B Dairy <br />FOOn PROGRAM <br />f16001 <br />Please Mark the Appropriate Description and Specify Size and/or Number of Units where applicable: <br />Milk Diepaneer I Ntmber of Containers in Mtrlti-Rend Unit <br />HAZARDOUS WASTE PROGRAM {2200} <br />I Tons genernt.d per year <br />azardous Waste Generator <br />' C.wgoricelly authorized Cntegon-Ily Exempt Permit by Rd. <br />ered Permit Facility <br />HOUSING PROGRAM {2400} EMPLOYEE HOUSING tllUU} <br />1 Number of Units Number of Snploye.s Datiry SnPloye. Housing IIS <br />FHolellMotelApproximate Dates of Occupancy <br />or Exempt Institution 10 <br />LIQUID WASTE PROGRAM {4200} <br />I <br />I Re Oistrndon A` 1 Lie.— 9 1 Capacity I Vehicle 7 <br />Pumper Vehicle t <br />� Ntxnber of U-1.� <br />Pum er Yard Packa a Treatment Plant Chemical Toilets <br />Il/lrnr WAc-m PRnr_uAm ia�nni <br />..�......� .. .. t ---i <br />I Senting Cnpnciry <br />I Sguare Footnse <br />Produce Stand <br />Ice Plant <br />Restaurant <br />Skilled Nursing <br />Large Generator <br />Process/Recycle Facility <br />Ntanber of Unit■ <br />Dum sters > 20 cu yd <br />I Div stnrngn only <br />I ..(IlFnod N.P.-ti.. <br />Small Generator <br />Vendin Machines <br />Nunber of Units <br />Commissar <br />I <br />2 - 10 generators 11 - 60 generators > 60 generator. <br />Common Storage Facility I <br />I snunre Fmrtnoe <br />t wirh Mem Marker orYy <br />' with Fnod Pupntntion <br />I Div Good. oNv <br />Retail Market <br />V.liol. Tyne <br />' Color <br />' R.gi.uedon Ir <br />I Uc.n.. S <br />Food VehicleI <br />I <br />t <br />I <br />1 Mnke <br />li <br />' Vecl. Tvn. <br />' Coto, <br />o <br />' Reg s <br />' U..n.. <br />Mobile Food Unit <br />t <br />I <br />t <br />I <br />1 <br />Temporary Food Facility <br />Special Event <br />Data. of Onernlion <br />froth <br />to <br />Orates of Operntion <br />from <br />to <br />HAZARDOUS WASTE PROGRAM {2200} <br />I Tons genernt.d per year <br />azardous Waste Generator <br />' C.wgoricelly authorized Cntegon-Ily Exempt Permit by Rd. <br />ered Permit Facility <br />HOUSING PROGRAM {2400} EMPLOYEE HOUSING tllUU} <br />1 Number of Units Number of Snploye.s Datiry SnPloye. Housing IIS <br />FHolellMotelApproximate Dates of Occupancy <br />or Exempt Institution 10 <br />LIQUID WASTE PROGRAM {4200} <br />I <br />I Re Oistrndon A` 1 Lie.— 9 1 Capacity I Vehicle 7 <br />Pumper Vehicle t <br />� Ntxnber of U-1.� <br />Pum er Yard Packa a Treatment Plant Chemical Toilets <br />Il/lrnr WAc-m PRnr_uAm ia�nni <br />..�......� .. .. t ---i <br />Transfer Station <br />A iCa nery Waste Site <br />CIA Landfill Site <br />Primary Care <br />Acute Care <br />Skilled Nursing <br />Large Generator <br />Process/Recycle Facility <br />Ntanber of Unit■ <br />Dum sters > 20 cu yd <br />Small Generator <br />Transfer Station <br />Limited Hauler <br />Veterinary Clinic <br />I <br />2 - 10 generators 11 - 60 generators > 60 generator. <br />Common Storage Facility I <br />RECREATIONAL HEALTH PROGRAM {36UU} <br />of PoofslSpns rat Fncifity <br />SITE MITIGATION PROGRAM f 2900 <br />lvironmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br />I Cd EPA - RWGCB I Cal EPA - DTSC 1 US -EPA <br />ther Lead Agency Site L 1 I <br />I NPL Site 1 Water Ounlity Site I Oth.r <br />SOUD WASTE PROGRAM {4.400} <br />Landfill <br />Transfer Station <br />A iCa nery Waste Site <br />CIA Landfill Site <br />Sludge/Ash Site <br />Compost Facility <br />Number of Unit. <br />Refuse Vehicles <br />Waste Tire Facility <br />Process/Recycle Facility <br />Ntanber of Unit■ <br />Dum sters > 20 cu yd <br />VECTOR CONTROL PROGRAM {4000} <br />Maximum Nienber of Birds <br />Poultry Farm <br />Snerg.ncy Noolinntion for this FACIUTY mtdlor PROGRAM <br />CONTACT PERSON: n � f Arris N lt(jS[7Y� <br />Kennel <br />Onv <br />1 NlQlat <br />I <br />