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V COUN`ry PHS-ENVIRONMENTAL HEALTH DIVISI MASTERFILE RF 'ID INFORMATION FORM(EH 00 591nea1eed 61941) <br /> N <br /> FH PrograndlExieflng Facility New EH Program/New Facility r Darte <br /> SHADED SECTIONS FOR LOCAL USE ONLY ; 3' <br /> FACILITY ID At RECORD ID # C�D11 1' 9 <br /> Pleeae Mark the Approprlace Deagrrptron and Sp fy Size arnoll.,Number f Unit where ppl..his: <br /> _DAIRY PROGRAM {2000} <br /> Grade A Dairy Grade B OMry <br /> Milk Dispenser Number,of Conor,err in Mnifi-Head Unit <br /> _ <br /> FO 30 PROGRAM {1600} <br /> I Sealing capacity I Square Footage Produce Stand ICs Plant <br /> Restaurant <br /> Number of UNa <br /> 1 Dry storage only I wuh Food v.epemfiom Vending Machines <br /> Commissar <br /> I Sgnnre Footage <br /> I with Meet Market only I with Food Preparation I Ory Goods only <br /> Retail Market <br /> I Make I Vehicle Type � Color � Reglatratlon a I futures.t <br /> Food Vehicle I I <br /> 1 I Cola. ' R• hr'-fion I I U..... <br /> I Make VeNcle Type 1 I 1 <br /> Mobile Food Unit I 1 <br /> FTemporary Food Facility Special Event <br /> 0 ..... from tq Data.of crowd.. from to <br /> _-HAZARDOUS WASTE PROGRAM {2200} <br /> 1 run.g.ne..I.d par rear <br /> Hazardous Waste Generator <br /> categorically authorized Categorically Exempt Permit by Rule <br /> Tiered Permit Facilit I <br /> HOUSING PROGRAM {2400} MPLOYEE HOUSING {2700} <br /> I Number of UNb Number of Employee. Dairy Empioyee Housing <br /> Hotel/Motel <br /> Approximate Dews of Oacupnnoy <br /> Jail or Exempt Institution tO <br /> _DQUID WASTE PROGRAM {4200} <br /> 1 astir....tlon A I uc une R 1 Capacity I Vehicle a <br /> Pumper Vehicle <br /> Number of Units <br /> Punt er Yard I Package Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> rS.',.Ial <br /> r Care Acute Care <br /> Skilled Nursing <br /> Ler a Generator <br /> Generator Transfer Station Lilllited Hauler Veterinary Clinic <br /> 2-1O generators 11 -60 generators >5ogen•ratou <br /> mon Store a Facility1 <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool <br /> Spa Out of Service PooUS a Nature] Bathina Area <br /> Number of Pool.ISpa.at Facility Pool/spa IO O <br /> SITE MrncanON PROGRAM {2900} <br /> Env'vanmental Assessment USTICAP Local Hat Waste Net Mat Pipeline <br /> Other Lead Agency Site i cal EPA-RWQCB 1 Cni EPA-DTSC 1 US-EPA <br /> 1 NPL Site 1 wars Quality site I other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station AqlCannery A /CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Number of Unit. <br /> Waste Tire Facility Process/Rec ele Facili Dum eters >20 cu vd Number of Unit. <br /> VECTOR CONTROL PROGRAM {4000} <br /> 11 PoWtry Farm Maximum Number of Bird. Kennel <br /> Emergency N.Ifrc nirm for rule FACILITY and/or PROGRAM Day higiu <br /> CONTACT PERSON= I O <br /> Designated Employee A Program Element Cerra r stet Numb•r of Unib FPA I ^ /�S <br /> Rroaw.d by Dote lrwmwyy.d by Data coeuntng O me ate T77= <br /> ere ryl a ere <br />