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SJ COUNTY PHS-ENVIRONMENTAL HEA TH DIVISIJS MASTERFILE RF J INFORMATION FORM{Ell 00 691Reyised 6/941} <br /> New EH Program/Existing Facility New EH Program/New Facility r Date <br /> SHADED SECTIONS FOR LOCAL US ONL�Yy .11zA <br /> FACILITY ID # RECORD ID # D�74�D <br /> Please Mark the Appropriate Description and Specify Size end/or Number of Units where applicable: <br /> DAIRY PROGRAM {2000} <br /> G reDairy Grade B D.ir Milk Dispens.r Number of Containers in Multi-Mend Unit <br /> FOOD PROGRAM {1 600) <br /> I S—ung Ca .ity 1 Sguere Footage <br /> ' Restaurant Produce Stand Ice Plant <br /> 1 Dry Storngn only 1 with Fnod P-pnrntir,rh Numb.r of Unit. <br /> Commissar Ven ling Machines <br /> Squnrn Foo aqe 1 with Ment M.rk.t only I with Fnnd P-primtlon I Dry Good.only <br /> Retail Markel <br /> 1 Mak. 1 Vehicle Type t Color t Registration # 1 Ucen.e# <br /> Food Vehicle I I 1 1 1 <br /> 1 Mak. 1 Vehicle Type 1 Color f Registration # 1 Ucen,e# <br /> Mobile Food Unit I I I 1 1 <br /> Temporary Food Facility Special Event <br /> Dnte9 of Operation hem to Data,of Operation from to <br /> HAZARDOUS WASTE PROG M {2200} <br /> I Ton.gmh—mr! per y.nr <br /> Hazardous Waste Generator ���111 <br /> Categ.d.olly authorized Categorically Exempt C Permit by Rule <br /> Tiered Permit Facilit %' <br /> HOUSING PROGRAM 12400 EMPLOYEE HOUSING {2700} <br /> umber of Units Nu nb.r or Employee, Dairy Employe. Housing <br /> FHtelotel <br /> Approximate Dat—of Occupancy <br /> xempt Institution to <br /> LIQUID WASTE PROGRAM {4 001 <br /> 1 R.gi9umi.o # t Uc9-9 # 1 cap—ity, 1 Vehirle# <br /> Pum er Vehicle 1 1 <br /> 1 Number of Unit, <br /> Pum er Yard Package Tre anent Plant Chemical Toilets 1 <br /> MEDICAL WASTE PROGRAM 4500} <br /> Primary Care Acute Care Skilled Nursing Large Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facility j 2-10 generators 11 -60 generator. >60 generntors <br /> RECREATIONAL HEALTH PROG M {3600} <br /> Pool S a Out of Service Pool/Spa Natural Bathing Area <br /> Numb9r of Pools/Spas at Facility Pool/Spa ID# <br /> SITE MMGATION PROGRAM { 9001 <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> 1 Cnl EPA-RW QCB I C.I EPA-DTSC I US-EPA <br /> Other Lead Agency Site <br /> I NPL Site 1 Water Quality Site I Other <br /> SOLID WASTE PROGRAM {44 0} <br /> Landfill Transfer Stalion Ag/Cannery Ag/CanneryWaste Site <br /> Number of Units <br /> CIA Landfill Site Sludge/Asti ite Compost Facility Refuse Vehicles <br /> Waste Tire Facility Process/Rec cle Facility Dum sters >20 cu yd Number of Units <br /> VECTOR CONTROL PROGRAM 4000} <br /> Maximum Ntmber of Bird, Kennel <br /> PoulVy Farm <br /> Emergency,Notifi—tion for this FACILITY and/or PROM Day Night <br /> CONTACT PERSON: JUeQ �li-eZ 17O 8 3�0 X30 <br /> EA.—i—ed <br /> yee# Progr m Element ll n C' Current Status Number of Units EPA 10� <br /> Dote Roviewet by boto Ac.ot ting—Office net. Unit Clark to Unit Staff Date <br />