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-. Ivlr\JIU\Y 11_C 1.. ..vrrV nsr Vrn..r�rry r•.vr...r 1.... ... .._...�..�_-.'-._.,r <br /> SJ CG16NTY PHS-ENVIRONMENTAL HEALTH 0M <br /> New EH Program/Exleting Feoility New EH Program/New Faoility Vele <br /> SHADED SECT/DNS FOR LOCAL USE ONLY <br /> FACILItY Id k fir. IiECORb ID # <br /> Please Mark the Appropriate Desoription and Speoify Size end/or Number of Units where applioeble: <br /> DAIRY PROGRAM (20001 <br /> Orad.A Dairy Orede a Dairy Milk DI.pene*rNunber of Contdrwr■In Muttl Head UNI <br /> r . <br /> FOOD PROGRAM {1600) <br /> I Seetlng Capacity 1 square Fooleg. P odUCe Stand Ice Plant <br /> ?' estaurant <br /> 1 Dry Storage oy I with Food Prepared— Nunber of Writed <br /> Commissar Vendln Mechl tee <br /> I Footeg• <br /> I witlr Meet Market.,Ay 11 will,Fuad Pr.p.ratlon I Dry Good.o°ly <br /> aqum. 1 <br /> Retell Market t <br /> I Make i VoWle Type I color I Reglstr.dml f i uo.n.. f <br /> Food Vehicle I l I <br /> I Make I VdJols Type 1 Color I Registration f I Uo.n.o f <br /> Mobile Food Unit I I 1 l <br /> 1 t 1 <br /> TemporaryFood Facility Special Event <br /> Date*of Operation from to Date.of Operation Irom I° <br /> HAZARDOUS WASTE PROGRAM {22001 <br /> 1 Tons generated par year <br /> ' Hazardous Waste Generator <br /> I Calegorloelly outhodirrd <br /> I Ceugorloaily Exempt Pennh by Rd. <br /> Tiered Permit Fac1it <br /> HOUSING PROGRAM {24001 EMPLOYEE HOUSING (2700) <br /> I Nunbar of Units Number of 6nployse Dairy 6nployse Hou.ing <br /> ote Mote <br /> Approximate Date.of Ocoupnney <br /> Jail or Exempt Institution t° <br /> LIQUID WASTE PROGRAM {42001 <br /> v I Registration / 1 Uome. f 1 Cepeolty I V.Nol.f <br /> Pumper Vehicle <br /> Nunbar of Units <br /> Pum fir Yerd Package Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM 145001 <br /> rimer Care Acute Care Skilled Nursina Larne Generate* <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> ` 1 2•10 generators 1 11 •60 generators >60 a.—W— <br /> Common Storage Facility <br /> RECREATIONAL HEALTH PROGRAM 136001 <br /> P' <br /> Pool <br /> son Outo Sery cePool/Spa Nature Batlti Area <br /> Nunbar of Pools/Sp.. at Fwlllty Pool/ep.ID N <br /> SITE MMGATION PROGRAM {29001 <br /> Environmental Assessment UST/CAP Local Haz Waste Hez Met Pipeline <br /> 1 cd EPA•RWOCB I Cd EPA-Disc ; U6 EPA <br /> Other Lead Agency Site r -� <br /> 1 NPL Site I Water Quality site I Other <br /> SOLID WASTE PROGRAM {44001 <br /> Landfill Transfer St tion Ag/CanneryAg/Cannery Waste Site <br /> Number of UnitsCIA Landfill Site Sludge/Asti Site Compost Facility Refuse Vehicles <br /> Waste Tire FacilityProcess/Recycle Facilityw <br /> Dn eters >20 cu d N"qb•r of ur lt. <br /> VECTOR CONTROL PROGRAM {40001 ry t]. O y <br /> Mexirnten Ntanber of Birds Kennel <br /> Poultry Farm <br /> 6netgonoy Notification lot INs FACIUTY and/ r PRogRAM _ Day / Night <br /> CONTACT PERSON: ,/�/-� •' L ' G' �`� l �O�t l 8 0S J ( 1 <br /> parlglwUd BnWoya•t .( Proprntn 6ernsnl 7 'i Curgm Bletd► i Niettber of UNIT "7 <br /> EPA ID M I: <br /> a y yDate.:. av ewe y eU4 oo0un Itg os ata t t er atelujit fa Data <br /> sees <br />