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SJ COUNTY PHS - ENVIRONMENTAL HEALTH DI`"SION MASTERFILE RECORD INFORMATION FORM {EH 00 59tRevieed 619141} <br />New EH ProgramiFxisting Fpcility New EH ProgramiNew Facility Date <br />SHADED SECTIONS FOR LOCAL USE ONLY <br />LEFACILITY 1Q# RECORD ID # <br />Please Mark the Appropriate Description and Specify Size and/or Number of Unite where applicable: <br />DAIRY PROGRAM {2000} <br />Grade A Dniry <br />G -d. 6 Dniry <br />Milk Diepwnewr Number of Containers in Multi -Hand Unit <br />C.�...-. Drs --Dns- I1 cznnl <br />Restaurant <br />I swaona C.P.6ty <br />1 spun,. Foonane <br />Produce Stand <br />Ice Plant J <br />Large Generator <br />Small Generator <br />---7F—v..dinq <br />Limited Hauler <br />I ory storage only <br />1 with Fnod Ptepnrnbon <br />I <br />I 2. 10 generators <br />Machines <br />Number of Unite <br />Commissar <br />1 Srpmrw Fnurnge <br />I with Ment Mmkwt nrey <br />I with Food Ptwontadon <br />t D" Goode only <br />Retail Market <br />, <br />1 <br />Mnkw <br />I Vehicb Tyne <br />I color <br />I Reglegnoon f <br />I Uaeme d <br />Food Vehicle <br />I <br />1 <br />I <br />I <br />I <br />I <br />I <br />I Mnke <br />I Valiclw Type <br />I Color <br />I Regrstrnaon A <br />I Ucense s <br />1 <br />Mobile Food Unit <br />I <br />I <br />I <br />Teporary Food Facility <br />Speal Event <br />Daresmof Op—ti— <br />fro- <br />to <br />Oracites of Operedon <br />from <br />to <br />L HAZARDOUS WASTE PROGRAM {2200} <br />I Tons Qenerated per year <br />Hazardous Waste Generator I <br />Categorically authorized Cetego'—fly Exempt <br />Tiered Permit Facility <br />HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br />I Number of Unit. Number of bnployses <br />Fi.il <br />otel <br />Approximate Oates of Occupancy <br />xempt Institution <br />LIQUID WASTE PROGRAM {4200} <br />I Rwgistraaon 0 1 Ucensa f 1 Capacnty <br />Pumper Vehicle I <br />1 Nnmbe at Unrt <br />Pumper Yard —Package Treatment Plant Chemical Toilets <br />MEDICAL WASTE PROGRAM {4500} <br />I <br />Permit by MA. <br />Dniry Employee Housing <br />to <br />I Vwficle X � <br />I <br />Primary Care <br />Acute Care <br />Skilled Nursing <br />Large Generator <br />Small Generator <br />Transfer Station <br />Limited Hauler <br />Veterinary Clinic i <br />Common Storage Facility <br />I <br />I 2. 10 generators <br />I 11 - 60 generator• <br />1 <br />> 60 generous <br />RECREATIONAL HEALTH PROGRAM 136UUI <br />Pool I S12a Out of Ser <br />Number of Poole/Spas at Facility Poollspe 10 I <br />SITE MITIGATION PROGRAM {2900} <br />Environmental Assessment I USTICAP <br />Local Haz V% <br />CA EPA - OTSC <br />were, Ouafity S <br />SOLID WASTE PROGRAM {4400) <br />i <br />Landfill Transfer Station Aq/Cannery A/CanneryWaste Site <br />Number of Units <br />CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br />Number of Units <br />Waste Tire Facility Process/Recycle Facility Dum sters >20 cu yd <br />VECTOR CONTROL PROGRAM {4000} <br />i. <br />Mnxrmrm Number of 840s <br />Pl Farm Kennel <br />I autry <br />Bnnrgency Noulir.ation for ,hie FACIUTY nndlor PROGRAM Dev Night <br />CONTACT PERSON: <br />Des,grtatwd Employee ? I Progrrm Element Af , 31 Current Stnnn I Number of Unit 1 EPA ID f <br />