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_ SJ COUNTY PHS-ENVIRONMENTAL HEALTH DNISF MASTERFILE RE' 113 INFORMATION FORM{ H 00 59M.vbaa areal} <br /> /Ex t 9 FIny N EH P 9 /N Facility Date FNP g �a3 <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> FACILITY ID # i RECORD ID # <br /> Please Mark the Appropriate Description and Specify Sae and/or Number of Units where applicable: <br /> _DAIRY PROGRAM (2000) - -- 507.-E lo 1):L. _ c„ <br /> Grnd.A Uniry Grnd.B Dairy Milk Di...n.e. Number of Containers In Mult-Heed Unit <br /> _FOOD PROGRAM (1600) <br /> 1 seat.,c."eity I S,.rs F.onng. Produce Suri Ice Plant <br /> Restaurant <br /> I try s.......my I with Food rrope.nnon VendingMachines Number or ude. <br /> Commissar <br /> I Sans Fpetnga I wth Meet Market oMy I with Food prep...don I Dry Goad.eMY <br /> Retail Market <br /> I Make I Va1Ha1.Typ. I Color I RagblreH.n! 1 U.. .! <br /> Food Vehicle 1 - I 1 1 <br /> I M.ke I Vehicle Type 1 Col.r Red.trntar ! Us. ..! <br /> Moble Food-Unit <br /> F 1 1 <br /> Temporary Food Facility Special Event <br /> Dole..1 0,snMonnem to o.1.,of ope..non from .p <br /> HAZARDOUS WASTE PROGRAM {2200) <br /> I Tone g•^•ra.ed per year <br /> Hazardous Waste Generator <br /> Categorically authorized Cegode.11y Eeampt Permit by Rule <br /> Tiered Permit Facilityb <br /> _ HOUSING PROGRAM {2400) _ EMPLOYEE HOUSING J270D) <br /> 1 Nwnber of llMte Number of EmploYeen Dairy Employee Housing <br /> Hotel/Motel <br /> AVproaimnt.Unn.s of 0..upnn.y <br /> Jail or Exempt Institution t° <br /> _LIQUID WASTE PROGRAM {42OD) <br /> IF1 Ra,bnrnton A I Ucen.e! 1 Cnped.y I VeNda If <br /> —Pu_ <br /> um er Vehicle <br /> 1 Wants,of Unit. <br /> Purnpeir Yard Package Tr tment Plant Mchernical Toilets <br /> MEDICAL WASTE PROGRAM {4500) <br /> IFP"..'v Care Acute Care Skilled Nursing Ler a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common StorageFacilit 2-In...emto,. 11 -sog......... i >so......... <br /> RECREATIONAL HEALTH PROGRAM {3600) <br /> Pool S a Out of Service Pool S e Netlael Bathin Aree <br /> Nrnnber of Poolaapne n.Facility Pod/Spa IG! <br /> SITE MmGAnoN PROGRAM (2900) <br /> Environmental Assessment I USTICAP Local Haz Waste Her Mat Pipeline <br /> I CM EPA-RWGCe I Cd EPA-OTSC I US-EPA <br /> Other Lead Agency Site <br /> 1 NPL Sire I Water threat,Site 1 Other <br /> SOLID WASTE PROGRAM {4400) <br /> Landfill Transfer Station Au/Cannery Waste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Numbar of uait. <br /> N.b.,of U.rl.. <br /> Waste Tire Facility ProcesslRec cls Facilitv, Dum stere >20 cu yd <br /> VECTOR CONTROL PROGRAM (4000) <br /> Poultry Farm Mourn.Number of Bird. Kennel <br /> Emergency Nonncnnon for.N.FACILITY and/or PROGRAM Day NIu1,1 <br /> CONTACT PERSON: ( ) ( ) <br /> EDesiq�todyee d Pwg.No 9eme9{,/ yCa.renl son. Nwnber of Unit EP lD n.a evrewe y Meta cmwr ng roe Veto nit Clerk .1. rv. w nits <br />