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SJ-COU1gTY PHS-ENVIRONMENTAL HEALTH D� MASTERFILE ID INFORMATION FORM(EH 00 591aevi.nd 61941) <br /> New EH Program/Existing FacilityDL_ New EH Progrom/New Facility Deta <br /> SHADED SECTIONS FOR LOCAL USE ONLY ]3 <br /> FACILITY ID # ,-, RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size end/or Number of Units where applicable: <br /> DAIRY PROGRAM {2000} <br /> Grntle P Oniry Grnd.8 Dalry Milk Dlspemer Ntmber of Cgnnirnn In MWtlHend Uric <br /> FOOD PROGRAM {1600} <br /> I seaong C.P.dry I Savar.Footage <br /> Restaurant Produce Stand Ice Plant <br /> Commissary <br /> I Dry Storage not, I with Food Prsp.ranon 11 Vending Machines Nnnber or Units <br /> I Srnoo.F-1.1. I with Ment Market only I with Food Preparation I Dry Good.ooly <br /> Retail Market <br /> I oink. I Veltlol.Ty.e I Color I Realatrn kn' a I Us.m.a <br /> Food Vehicle I I I I 1 <br /> I Maka I Velida Type I Color 1 aegletrno.n/ I Uoen.a a <br /> Mobge Food Unit I I I I I <br /> Temporary Food Facility Special Event <br /> Dene of Operation <br /> born m Cato.or op.ranon trom to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> I <br /> Hazardous Waste Generator Tons generated per ye.r <br /> Tiered Permit Facility i C.mgonoally.amorix.d i enagodeally Exempt "-7 3 i Permlt by Rule <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} L <br /> I NumFN. <br /> b.,at Units b.r of Employees Dairy Employes Hou.ing <br /> Hotel Motel <br /> Approximate notes of Opcupnhe <br /> Jail or Exempt Institution r• <br /> LIQUID WASTE PROGRAM {4200} <br /> 1 Redananon O I Ucen..a 1 Capacity I Vehiel.0 <br /> Pum er Vehicle <br /> Pumper Vatd Package Treatment Plan[ Chemical ToiletsNornber of Units <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursing Lar a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facilityi 2-10......tore 11 -so genaramr. i >so generator. <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> F1----l <br /> S a Out of Service Pool/Spa Natural BathingArea <br /> bo or Pod- <br /> ISP..at Facility Pod/spa ID Jr <br /> SITE MmGATION PROGRAM {2900} <br /> Environmental Assessment I UST/CAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site 1 CN EPA-RWQCB I CN EPA-DISC 1 US-EPA <br /> 1 NPL site I Water Qrnlhy site I Minn <br /> SOLID WASTE PROGRAM {4400} <br /> rC1 <br /> lTransfer Station A /Canner Waste SitaLandfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Number.r unit. <br /> te The Sit <br /> Process/Rec cle FacilityDunt sters >20 cu d Number.r unit. <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm <br /> Maxuu <br /> imn Number of Birds Kennel <br /> Emergency Noonceoon for do.FACIUTY.nail.,PROGRAM Day Night <br /> CONTACT PERSON: I ( I <br /> Eewd,�plo PDnnt# Curt Status Nmer of Unte � u2-1-25 :1 <br /> Receive <br /> ate evlewe y Data oount ng ms ate nit o. me t Staffme <br />