Laserfiche WebLink
SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVISK MASTLAFILE RF D INFORMATION FORM {EH 00 69(R-1..d areal} <br /> New EH Program/Existing Facility New EH Program/New Facility I Data <br /> SHADED SECT/ONS FOR LOCAL USE ONLY <br /> FFFACILITY ID # RECORD ID # <br /> Please Mark the Appropriate Description and Specify Sae end/or Number of Unite where applicable: <br /> DAIRY PROGRAM {2000} <br /> 7 ' <br /> Grade A one, Grace a Dalry Milk Manana., Number of Container.In NOW Head Unit <br /> FOOD PROGRAM {1 6001 <br /> 1 Seating Cepa dry I 6gaere Foorga <br /> Restaurant Produce Stand Ice Plant <br /> I Dry Storage only I with Food Preparafen Number of Unit. <br /> Commissar Vendina Machines <br /> I <br /> Retail Market Aqua..Feet., I with Meal Market.nly I with Food Preparation Dry Goods only <br /> Food Vehicle <br /> Make 1 V.N.I.Trp. I Cdor I Registration# 1 Uwm.a <br /> 1 1 I 1 1 <br /> 1 <br /> Mobile Food Unit Make 1 V.190.Type 1 Color 1 Re Oblrndpn a 1 U.....# <br /> I 1 1 1 1 <br /> Temporary Food Facility Special Event - <br /> Detea of Operation hoe m Data.of Opereaon fere to <br /> HAZARDOUS WASTE PROGRAM {2200} y- <br /> Generator <br /> I Ton.......red par ra.r <br /> Hazardous Waste a., <br /> Tiered Permit Facilityi Cemgod.any .0 nnd:. ; ibA.WWMMIMEnW2 1 Permit by Rd. <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> Hotel Motel I Number of Units Number.f DnplgYee. Odry Eor <br /> npie.H,nethw <br /> Jail or Exempt Institution Appr.am,.t. ume..1 op.apan.r a <br /> LIQUID WASTE PROGRAM {4200} <br /> Pumper Vehicle 1 Regl.tratian# f LIcenae# I creed, 1 vowel.# <br /> 1 <br /> Pumper Yard Package Treatment Plant Chemical Toilets Number of Uwr1 <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursina Ler a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facility <br /> 2.10.......I— N r-6a generators >60,a....I.r. <br /> ' <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> spa Out of Service Pool/Spa Natural BathingArea <br /> Nunber of Poole/Bpas <br /> at Frailty Pool/Sp.ID A <br /> SITE MmcATiON PROGRAM {2900} <br /> Ervironmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site I Cel EPA-RWQC6 1 Cal EPA-OTSC I US-EPA <br /> rl I NPL Site 1 Warr Quality site 1 Other <br /> SOLID WASTE PROGRAM {4400} <br /> ffClA ,d <br /> Transfer Station A 1Canner Waste Site <br /> ll Site Sludge/AshSite Compost Facility Recuse VehiclesNmnar of UwbNmnbar of Unite <br /> Site <br /> Process/Rec cle Facility <br /> num stere >20 cu yell <br /> VECTOR CONTROL PROGRAM {4000} <br /> Poultry Farm Meaimmn Nmnbar of Slid. Kennel <br /> Emorgency Notification for this FACILITY angler PROGRAM Oay Night <br /> CONTACT PERSON: ( ) ( ) <br /> E <br /> oyee A Prbgrmn Gement# Current Srtua Nmnbar of Unit. EPAIGz- r.re —i— v ate cmmrl ng me. at. ret at. Data rt 'an mo," <br />