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SA.N TOUIN COINTYENVIRONNIENTAL HE,A.LTI-I DEPARTMENT <br /> MASTFRUL____,F,RECORD2EORMATTV 1 ORM <br /> vv a promm at Existing Facility l ll Pio and New racitity <br /> Facilif ID Y Pro ram Reeord ID <br /> £acilily'Address` <br /> (Plea$c Heir the appropriate description iiiid specify 114e o4inber or units and pertinent iiif_atian.), <br /> rOOD PROGRAM Q60©) <br /> ,._ <br /> 'Rest ttrant = catitig Capacity 5quaze 1 aotage food Hiiiilic�s'Vour�e reolred: YES C] No❑ . <br /> CommtssarY DDFys#Qrage,osity. 13ruithFoodt'reparaEiora I Pettdittd114achines NumbcrofUnits <br /> d Refait""l�ta=3:e(`=- Square footage Q ttfi Meattvfarket°ority Mttl#ip3e lleparhnenEs 11 Prepackaged Goods t* <br /> [ ;Mobitp.Food c <br /> � hicler-Make Colar` <br /> f - <br /> U� Registration# Luse <br /> Sticker <br /> R'hxobile Food Prep Unit--Make Velucle Type = Color ; <br /> Registxation# License# Sticker# r,> <br /> Q,Teitpora Food P a t ---dates or Qperation fr©m to <br /> ❑Ice Plaut, <br /> [ Sy�pceiia��tEyeat —Date$of operation from -_ 7 77 ��to L�.....Pradaice`Staid'' <br /> ovial <br /> { Grade <br /> Da 3�' <br /> 'Grade B Dairy 0 Mitt.IlicpcIIser Nut jn- of.Conkaircets iii Multi Teai [Tnit` 6 <br /> G+rrF A CI s a ' <br /> ar/g ( 9Iq (y/� <br /> (220,)) <br /> C1 ltiazardons 4Yaste Generator „T" s"ae drated Fist"Y eai ©Recycle I,,Eacmpt System 22 9) <br /> 13 "Ic�yclii` '11n9) np is ceD ) crs(221 } <br /> re 'rextmttiugfad y,:, b Caiiditionally Authgri=d(CA) Q t*andztzo alley T mpt SGL) <br /> Q Pertnit-By-Rule FiiCz unit b 1'crmit Byaute s7 <br /> ©Al3a STgRAGE TANK] € �`(AS-1)(2390Nuts ber ofA.ST <br /> `° oA TANG(uj ©Gzal ( o) rrr. `iia rotes <br /> 1 <br /> HuteUMofeI Number of Units " ' Jail or Exempt Institixtion Number of Units <br /> >x� to ee;R°istrtTtSfi°T/xe t-u-e)Tusrn ICalwr�tC/tfll dr dit�rc i*vrm' z ` <br /> s, <br /> F y L( } : <br /> SITE MiTIGATiUN(2900) UNDERGROUND INJECTION CORTE P 3000) <br /> I;IIvironiuientalAssessmcnt Q USIM A1'Sit, Q Lir#a1 eaiiul Site C3 NPT JSEP Cteannp SY#c 13=0 €,, <br /> 33 AW Ldoned Hw site b non-NPL15>1P.Cleanup Site ❑R�3't c roup Site 3 Yater tZriality Remediation' <br /> r kEcREATIONAL HEALTH PROGRAM{36x40) <br /> U141-0 fPcSiitslSpas aEFacility Q Pool; �ut afSemvicePabVSpa' 3�NataraI BathiugArea <br /> VEOTOR CONTRO PR6GRAiVt(4000)" <br /> . 3 leo net <br /> ' Poaif''ry B'arni—Maximum number <br /> ATTC#O`=;3STE11f"f"EL'RCING'FER.HiATtt�NT COSMEE EC�'RbGRA1VI(4X,U(?) <br /> „/. <br /> Tattooing(4121) Body Pierciaig(412¢) Perinaneat Cosmetics(41 ) <br /> tQL1i `WA ti`F PRUGILAM(4�0k7) <br /> Uri Yehlcie�Rcgiskratlon#: . ',. I.tce�ise# � i �, i�ehicI <br /> Cl Pamper Yard Q Package Treatment Plant <br /> d t�tieniicai Toilets ---Number of Units <br /> SOLID ifASTE-PP_OGkAM(4400) <br /> b Landfill D Trans[er Sta#ian ❑ /Caimeryt'xste Site L7 Stud e(A'sii 9rte <br /> 13 WiiteTire`Factliiy b"Compost Facility 13 rrocessMtcydeFadiity ❑CIA,,Laudfill Site <br /> Q Refuse veluctes yNnrnber of?7nsts 3�Dumpsfers>20 cu Yd number of Units r_ d'FariuCltancli Cleanup Site <br /> MEDICAL WASTE PROGRAM(4599) .. <br /> 3�PnznaiT,Carc Q Acute Care ❑Stdlled Nursing Q Large Generator ©Small Generator 3.7 Limped Hautes <br /> g y <br /> ��ransfersta.(iou_., Cl;�eteriIIary�:linie �C3 Coinman--Stora a 3+`acltit ----�2-I0 ❑.: 6�giwnerators �' <br /> ISI#Lt'C` tti t1*#2 SYSTEM PROGRAM(4600)tfsePSEFXJ1,46{� -Q43”I3frr 4RpEicufiun urrt <br /> EMtRG, NCY NOWMATION FoRTllts FACILITY AND/ortftOGRAM <br /> CONTACT PERSON `DayF,Ph Night Ph <br /> 1'ACl(:RAM E _ TLLM �i d Other FEE, <br /> u <br /> INSPEctCiR# PERMIT VALID t4 0 Food Handier <br /> 3�Cock 0 AMOUNT PAIti' Date I�TStdIGE� . <br /> 0 Cash RviEWEvw ACCOUNTMG©r" CF Date ` <br />