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SJ CO.VJ4TY PHZ' -ENVIRONMENTAL HEALTH DIVIGN MASTERFILE RF D INFORMATION Fo.m(ol on Gern..i...r eioil <br /> New EH Program/Existing Facility New EH Program/New Facility pate <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> ECILi <br /> Please Mark the Appropriate Description and Specify Sae andlor Number of Unite where applicable: <br /> DAIRY PROGRAM {2000) <br /> Grade A Dairy Gr- <br /> da 8 Dalry Milk Dispenser Number of Containers In MrddJfead Unit <br /> 71 <br /> FOOD PROGRAM (1600) <br /> f Seating Capacity I Square Footage <br /> Restaurant Produce Stand Ice Piant <br /> I Dry Storage oriy 1 with Food Preparation Vending Machines <br /> Number of Units <br /> Gammissa <br /> I Square Footage I with Meet Market only i with Food Preparation f bry Goods only <br /> Retail Wrket <br /> I Make � Vehicle Type i Color � Registration• � Uoense I <br /> Food Vehicle I <br /> I <br /> Make Vehicle Type color Registration S uesme <br /> Mobile Food Unit <br /> Temporary Food Facility Special Event <br /> Dates of Operation from to Dates of Operation from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> I Tons generated per year <br /> Hazardous Waste Generator <br /> t Categorically authorized Categorically Exempt Parnell by Rule <br /> Tiered Permit Fecili f <br /> HOUSING PROGRAM {2400) EMPLOYEE HOUSING {2700} <br /> I Number of Unitsrtp.,trrn.,. <br /> of Employees Dairy Employs*Housing <br /> Hotel/Motel <br /> Detas of Occupancy <br /> Jed or Exempt institution to <br /> LIQUID WASTE PROGRAM {4200} <br /> 1 Regletretlon;r 1 Ucanse Jr 1 Capacity f vehicle Ir <br /> Pum er Vehicle <br /> Number of Unia <br /> Pumper Yard Package Treatment Plant Chemical Toilets F <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursina Larne Generate <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> I 2-10 generators 1 1.60 generator Y 6o generator <br /> Common Storage FacilityI <br /> RECREATIONAL HEALTH PROGRAM (3600) <br /> E—ml <br /> spa Out of Service POOI S a Natural Bathin Area <br /> oohl5pas etFooiltty, <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Haz Waste Hax Mat Pipeline <br /> Other Lead Agency Site l Cal EPA-RWGCB I Cal EPA-DTIC 1 U9.EPA <br /> I NPI.Site f 'Water Ouslity site I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Aa/Cannery Aa/CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Number or units <br /> Waste Tire Facility <br /> Process/Recycle ole Facilit Dum eters 720 cu d Number of Urias <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Maximum Number of Birds <br /> Kennel <br /> Emergency Notlficedon for this FACILITY andlor PROGRAM Day Night <br /> CONTACT PERSON: <br /> [leslgtteeea 6tlploYee pea idlll Uerh�m is t urrem etaHa Nrrlgber o!Urrlt! . EPA 16 M <br /> 4 <br /> ve ate eytsyr t► Doan g ate t o e-- t o ea <br />