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MAST EAFILE RF INFORMATION FORM(EH 00 59(1t.yned 111941} <br /> Si COUNTY PHS-ENVIRONMENTAL HEALTH DNISU -- _ <br /> /N EH P /N Facility D,; <br /> N EH P 9 IEA t 9 F IaY g <br /> SHADED SECTIONS FOR LOCAL USE UNY . <br /> - <br /> FACILITY ID # <br /> �d C)5' RECORD ID # 01 0 <br /> Please Mark the Appropriate Description end Speoify Srsa endlor Number of Units where ep)lipne�le: <br /> _DAIRY PROGRAM {2000} ;1„a j,;"z �j O7 017 <br /> Grade A Dairy <br /> Goes B Dairy Milk DNP en..r Number of Canteinen In Mulfi-Heed Uolt� <br /> _ FOOD PROGRAM {1600} <br /> 1 Sued.,c....hy I Soon,.Footnae Produce Stand Ice Plant <br /> Restaurant <br /> Nunber of Unit- <br /> Produce <br /> ory Strong.only I with Food P-lourreon VendinStrong. Machines <br /> Commissar <br /> F.omae I with Meet Merkur.My I with Food Prapemdon I Dry Good-.,4,Petal Market 1 s coo. <br /> 1 I Peaamtlon , 1 Uonne# <br /> 1 Mrrke 1 Veleela Type color I I 1 <br /> Food Vehicle I 1 <br /> 1 I Reaamtlon f I Uaame R <br /> I Mnke I Velicle Type I Cola, I I <br /> Mobile Food Unit 1 1 <br /> Temporary Food Facility 1 Special Event to <br /> oar..01 operetlon from to I Dree.or opemtlon Dom <br /> _ HAZARDOUS WASTE PROGRAM {2200} <br /> I Ton.9enemmd per your <br /> Hazardous Waste Generator <br /> C.te4oduelly nuthorized / CntaOodcnlly E°eVt e/ Permit by Rde <br /> Tiered Permit Facilit 1 m <br /> _HOUSING PROGRAM {2400} _ EMPLOYEE HOUSING 2700) <br /> I Number 9f Unin Number.1 EnploYee. Decry Employee Hou-Inp <br /> Hotel/Motel <br /> Appmxlmat.once-of Oneop-Troy <br /> in <br /> Jail or Exempt Institution <br /> _LIQUID WASTE PROGRAM {4200} <br /> I Rno.ptnkut J, 1 Ueanae# I Cep.Ow 1 Venule# <br /> purifier Vehicle <br /> Number of Unite <br /> Pumper Yard Packs a Treatment Plant Chemical Toilets <br /> MEDICAL WASTE PROGRAM {4500} <br /> Pflmary Care Acute Care Skilled Nursina enerator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facility z-10 y°"°`emr. i 11 -so a.ne,.mr- >BO 4enrna.0 <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool I Spa Out of Service Pool/Spa Natural Bathing Area <br /> somber of Poul.fspa-of F°ointy Poollsp.ID# <br /> SITE MITIGATION PROGRAM {2900} <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pi aline <br /> Other Lead Agency Site I Cel EPA-RWQCB 1 Col EPA-oTSC I US-EPA <br /> 1 NPL Site 1 Water Quality Site I Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Ag/Cannety Ag/CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Numb.,of Unit. <br /> Waste Tire FacilityProcess/Recycle Farli Dum stere 120 cu d N.b.,of Unity <br /> VECTOR CONTROL PROGRAM (4000} <br /> Maximum Nwnbe,of Birds Kennel <br /> Pouluy Ferm <br /> Em.ryermy Noeeoneon f.,09.FACILITY endlor PROGRAM Day Niaht <br /> CONTACT PERSON_ 1 ao9�3 - <br /> De-i9nowd EnploYee F praprnn Bement# � Current 8tnhe Nvmbe,M Unib` 'tel EPA ID/ <br /> ecowed by pw ..wed by V.I. aooum na O me U.41 Cl.,k r as Unt Stuffate <br />