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Si COUNTY PHS-ENVIRONMENTAL HEALTH Evew MAST ORD INFORMATION FORM{EH 00 69(R.w d em o) <br /> New EH Program/Existing Facility New EH Program/New Facility DeN, G 4Qi c <br /> SHADED SECT/ONS FOR LOCAL USE ONLY <br /> ID #` REcoadlD #FACILITY �� <br /> (ice i A)'• ✓fj/ i —�3J�����'Y�Pleme Mark the Appropriate Description and Specify Srta ardlor Number of Unna wMra aPPlfoabk <br /> DAIRY PROGRAM {200} ' <br /> Grad A Dairy Grace B oalry Milk d.wn..r Nunb.,of Connor.In mtjfti d Uri <br /> _ FOOD PROGRAM {1 600) <br /> I s..tlng C.d.dty I sg°e�.Faobge Produce Stand Ice Ptent <br /> Restaurant <br /> mm' - 1 Dry Storey.oalT 1 with Food R cal.d.n Vending Machine Number at UNb <br /> t` <br /> 1 Sri—Foobp. 1 with M.et Mer4.t onN I .duh Food R.p...to. 1 Dry Good.oNY <br /> Retail Market ' <br /> I Mai,. I v.Nc.Trw I calor I R.d....a..r ' tfmrv.s <br /> Food Vehicle I I I I I <br /> I MM. I V.Nd.Typ. I calor <br /> Moble Food Unit I I I I I <br /> Temporary Food Faclity �]FS-P-, <br /> cial Event <br /> oat..°I DPer.aon Iron to 'top...It.. hwn to <br /> HAZARDOUS WASTE PROGRAM f 2200 <br /> I o.n.retac <br /> Hazardous Waste Generator Ton. per y..r <br /> Tie ed Permit Facility i c.bgodcalry .uUwd:ac i cet.podeally usnpt Parmlt by Rde <br /> _ HOUSING PROGRAM {2400} _ EMPLOYEE HOUSING (2700) <br /> 1 Nub.,at UN. Nunbof finpl.y... Dalry bnploy..ftou.ing <br /> Hotel/Motel mo <br /> Apnmewnats D.b.of o°cuperay <br /> Jed or Exempt Institution to <br /> _ UQUID WASTE PROGRAM {4200} <br /> 1 R.drtrndan I I lion.. . I C.padry I V.Nde <br /> P p rVeh' I <br /> Number o1 uNb <br /> P Yard P ka a Treatment Plant _ Ch 'c 1 T l is 1 <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care - Acute Care Skilled N,,rsinq Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facilityi z-to generator' i t t -so g.n.'ator. i >so g.n.femr. <br /> RECREATIONAL HEALTH PROGRAM {3600) <br /> P I Spa Out of Service F' I/Sp Natural Bathing Area <br /> Nvnba of Poal.JSpn. at Fecairy Ppolape IDI <br /> SITE MITIGATION PROGRAM {2900} z -F <br /> Environmental Assessment ` UST/CAP Local Haz Waste Her Mat Pipeline <br /> 1 Cal EPA-RWOCe I Cd EPA-DTSC I USE A <br /> Other Lead Agency Site <br /> 1 NM Sib I 'W.I., Oudiry Mr. 1 01. <br /> SOLID WASTE PROGRAM {4400} Tjv l/. 0 9 �� <br /> Landfill Transfer Station Ao/Cannery A /CanneryWaste Site <br /> Numb.,of UnN <br /> CIA Landfill Site Sludge/Ash Site Compost Feclity Refuge Vehicles <br /> - Nunb.r of Udb <br /> Waste Tire Facility Process/Rec cle Faclft - Dum stere >10 cu yd <br /> VECTOR CONTROL PROGRAM {4000) <br /> Poultry Farm <br /> Me.imvn Nunber o1 Bird. Kennel _ <br /> Emrtg.rwy Nodag tl for IN.FACIUTY eM/or PROGRAM Dq Mght <br /> CONTACT.PFASON :,.; J J,,, <br /> • tMign.tid*Fmpley«• f' w F' 6inili`II.. C'..�.o._ ' ! Nimbir ollMb•.'•`:.. BADf ..`�' n' . <br /> ROOM <br /> later <br />