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lyoo wejQ 10() 2c: <br /> SJ COUNTY PHS-ENVIRONMENTAL HEALTH DIVIS' MASTERFILE R' RD INFORMATION FORM {EH 00 59m^•le^d 61941} <br /> New EH Progrem/Existing Facility New EH Program/New Facility r ""' Data <br /> SHADED SECT/ONS FOR LOCAL USE ONLY ' ' %'- <br /> FACILITY ID # I RECORD ID # <br /> Please Mark the Appropriate Description and Specify Size and/or Number of Unite where applicable: <br /> DAIRY PROGRAM {2000} - - <br /> Odds A ONry credo B Dairy Milk Di.pem.r Number of Conine,. In MultiHeadUnit <br /> FOOD PROGRAM {1600} <br /> 1 Sooting capacity I S.,ore Footage <br /> Restaurant Produce Stand Ice Plant <br /> Commissar <br /> 1 Dry Storage onlVendin Machines <br /> y 1 with Food Preparation Number o/unit. <br /> I S......Food,^ 1 with Meat Mokat only 1 with Food Rapnrngoo I Dry Oo^d.any <br /> Retail Market <br /> 1 Mxke 1 V.Nu1e Type 1 Cal., 1 Mpionolon# 1 Us.,..r <br /> Food Vehicle I 1 I 1 1 <br /> 1 Make I Whid.Type 1 Cala, 1 Rad.tmaon # <br /> Mobile Food Unit 1 I 1 1 1 <br /> Temporary Food Facility Special Event <br /> 11.1s.of Operation from t. Dears of o,.,.dan from to <br /> HAZARDOUS WASTE PROGRAM {22001 <br /> Hazardous Waste Generator 1 T...........l.d p.r .or <br /> Tiered Permit Facility <br /> j categorically authorized Categorically Ea^mpt Permit by Rnie <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700) <br /> 1 Nwnbar of Unlb Number of Employee, Dairy Employe.Hoodn, <br /> Hotel/Motel <br /> Approximate Untas of Ocauponcy <br /> Jail or Exempt Institution to <br /> Liam WASTE PROGRAM (4200) <br /> Pumper Vehicle 1 R^,ish.dan Jr 1 Ups...# 1 capacity 1 V.N.1.# <br /> Pumper Yard 11 Package Treatment Plant Chemical Toilets N..nbar of Urdu <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skilled Nursing Lar a Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> Common Storage Facilityi z 10 g..,md,. i 11 -so <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Pool Spa Out of Service Pool/Spa Natural Bathina Area <br /> Nnober of Poole/Spee.t Facility Pool/S,.ID# <br /> SITE MfnGATION PROGRAM .{2900} <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site I Cel EPA-RWQCB 1 Cd EPA-DTSC 1 USEPA <br /> 1 NPL Site 1 w.t.r Quality Site 1 Other <br /> SOLID WASTE PROGRAM {4400} <br /> Landfill Transfer Station Aq/Cannery Waste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility kD <br /> fuse Vehicles Numb.,of Unit. <br /> Waste Tire FacilityProcess/Recycle Facilit m stere >20 cu yd Numb.,or unt. <br /> VECTOR CONTROL PROGRAM {4000) <br /> Poultry Farm ^^^ni'^'"^Number of Blyd. Kennel <br /> Euro,—,Nadlleadon for this FACIUTY eadl.r PROGRAM Day Nl,ht <br /> CONTACT PERSON- ( I <br /> EI.d . Program Bement# — current Stat,. Numb^,of Unit. _C ts09ZC2-Data Prymo,rrd by net. Ac...a ng Write Do. Un.t Clark Dat. Unit Staff Do,. <br />