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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISION MASTERFILE RECORD INFORMATION FORM{EH 00 59(Revls,d 6/941) <br /> New EH Program/Existing Facility New EH Prograne/N I Dete <br /> SHADED SECTIONS FOR LOCAL USE ONLY ad'JZ <br /> FEFACILIrV ID # 0 )11611 RECORD ID <br /> Please Mark the Appropriate Description and SpecifySfze end/or Namber of Units where applicable: <br /> _DAIRY PROGRAM {2000} - 17-77 1 � <br /> Grade A ONry Cited.B Dalry Milk Dlep.naer Number of Can1 <br /> -1.In Multi-Heed Unit <br /> _FOOD PROGRAM {1600} <br /> I saner,Capacity I square Footage Produce Stand ir Ice Plant <br /> Restaurant <br /> 1 with Food Pre Non Number of Unita <br /> 1 Cry storage oNy narn Verdin Machines <br /> Commissar <br /> 1 square Footage I eeltb Mae,Marker orgy I with Food Pripemfi.n 1 Dry Good.only <br /> Retail Market <br /> I Make I Velgcle Type I Col., I Regietretipn f Ugepo f <br /> Food Vehicle I I I I <br /> I Mak. I vehicle Type Color i Regislrnti.n i ; Ucan.e R <br /> Mobile Food Unit I 1 <br /> Temporary Food Facility Special Event <br /> Date.of operation lane to De tea of Opaetlon fmm to <br /> _ HAZARDOUS WASTE PROGRAM {2200} <br /> 1 Tone.....need per year <br /> Hazardous Waste Generator <br /> Categodcefly outhodzem <br /> .cl / Categorically Exempt P.rmit by Rd. <br /> Tiered Permit Facility <br /> HOUSING PROGRAM {2400) EMPLOYEE HOUSING (2700) <br /> I Number of Unita Number of Employ... —11 Dalry Employee Heinle, <br /> HotellMatel <br /> Approabnna Deae of Ocauvermy <br /> Jail or Exempt Institution to <br /> _LIQUID WASTE PROGRAM {4200) <br /> I Regi.Vntivn A I neer..A I Capacity I vehicle R <br /> Pum er Vehicle <br /> I North.,of unityPum er Yard Package Treatment Plant Chemical Toilets <br /> I <br /> _MEDICAL WASTE PROGRAM (4500) <br /> Primary Care Acute Care Skilled NursingLar a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> I 1 11 -50 gen.own 1 >60.enenitor. <br /> I 2-10 ganeretore I I <br /> Common Storage Facility <br /> F§nnb�erof RECREATIONAL HEALTH PROGRAM {3600) <br /> S a Out of Service Pool/S a Natural Bathin Area <br /> Pods/Spee m Facility PnN/snn ID A <br /> _ SITE MITIGATION PROGRAM {2900) <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> 1 CN EPA-RWOCB I Cal EPA-WAC I US,FPA <br /> Other Lead Agency Site <br /> I NPL alb I Wear GuNlry bla I Other <br /> SOLID WASTE PROGRAM {4400) <br /> Landfill Transfer Station Aq/Cannery A /CanneryWaste Site <br /> Nlonbar of UNu <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles <br /> Nunber of Unity <br /> Waste Tire Facility Process/Recycle Facility Dum stere >20 cu yd <br /> _VECTOR CONTROL PROGRAM {4000) <br /> Maximum Nanbe,of ai.d. Kennel <br /> Poultry Farm <br /> Emergency No,ihcation for thio FACILITY red/or PROGRAM <br /> Dr, NLM <br /> CONTACT PERSON: NMI 1M C L L I alo 9 —07,Q <br /> Desigroad EnploYea A Pmga,n gem t f Currant atone,A Nuabv of Uniu EPA D f <br /> -71j <br /> .verve y nn. .vie y ale ceounpnq O me ab rat ale ret to ole <br /> �ly r00 <br />