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L400 Ir-605tT-`iOLk Dr-!,PP- <br /> SJ <br /> rl,reSJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISI MASTIERFILE R" ID INFORMATION FORM(EH 00 69111aeised 6/941) <br /> New EH Program/Fiisting Facility New EH Program/New Facility r Det. <br /> SHADED SECT/ONS FOR LOCAL USE ONLY <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 /> Crede A Dairy Grade B Dairy Milk Di.eamer Number of Contlern ns in M.16HeadUnit <br /> FOOD PROGRAM (7600) <br /> 1 Seting Cnpadw t S.aara Foouse <br /> Restaurant Produce Stand Ice Plant <br /> I Ory atmnge else I with Fwd Pm,se-11 r Noi.ber or Unit. <br /> Commissar Vending Machines <br /> Retail Market I soll Foomge 1 wfill Mae,Market only I with Food Prepnnnron I Dry Good.only <br /> Food Vehicle <br /> Make I Velsola Tee. I Color I S.'euetlon JrI Uoam.R <br /> I I I t I <br /> MAIL I Vehid.Tape I ca., 1 aepletrnr.n M I U.....! <br /> Moble Food Unit I I I I I <br /> Temporary Food Facility 1 Special Event <br /> Data.of On...sell from r to I Data.of Dearer.. r Innn t to <br /> HAZARDOUS WASTE PROGRAM (2200) <br /> I Tons g.n.mmd per year <br /> Hazardous Waste Generator <br /> Tiered Permit Facilit i <br /> C.......eily authorized Cn[egoripoly EAemp[ Permit by eels ^-Y <br /> HOUSING PROGRAM (2400) EMPLOYEE HOUSING {2700) <br /> I Number of Units Number of Dnployee. Decry Emeloy.. Hominy <br /> Hotel/Motel <br /> Jailor Exempt Institution APpmamnm Dema of o...Pat" to <br /> LIQUID WASTE PROGRAM {4200) <br /> Pum er Vehicle I a.psverort♦ I u....! 1 Capacity I V.Irde! <br /> Pumper Yard Package Treatment Plant Chemical Toilets 1 Nu fiber of Unit. <br /> MEDICAL WASTE PROGRAM {4500) <br /> LS- <br /> imer Care Acute Care Skilled NursingLar a Generator <br /> all Generator Transfer Station Limited Hauler Veterinary Clinic <br /> ommon Stora a Facility i z�10 g.nemwn. i 11-50...emmns i >60...emtor. <br /> RECREATIONAL HEALTH PROGRAM {3600) <br /> Pool I Spa Out of Service Pool/Spa Natural Bathing Area <br /> Number of Pools/Spee et Facility Pool/Spa tD! <br /> SITE MInGAnoN PROGRAM {2900) <br /> Environmental Assessment 1 UST/CAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site 1 Cd EPA-aWQCB 1 Cd EPA-DTSC US EPA <br /> 1 NPL Site 1 Water Gudiq Site 1 Other <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station An/Cannery An/CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Wln,ben of Unit. <br /> Waste Tire Facility Process/Recycle Facility Dum stere >20 cu yd Nan'bar of U 1. <br /> VECTOR CONTROL PROGRAM {4000) <br /> Poultry Farm Maeimmto Number of Bird. Kennel <br /> Unary...N.rf.nr.n for On.FACIUTY and/or PROGRAM pay Nlgbt <br /> CONTACT PERSON: ( ) I ) <br /> E <br /> N., Heinant R 2Za � current Stntua _ Win er of Units EPA ID! A eive , am =views y am counting D lice am nil er ate ret to .1. <br /> " .. <br />