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SJ COUNTY PHS-ENVIRONMENTAL HEALTH DNISr MASTLRFILE R' ID INFORMATION FORM(EH 00 691Real.ed 61941) <br /> New EH Program/Existing Fecilrly New EH Program/New Facility Data <br /> SHADED SECTIONS FOR LOCAL USE ONLY <br /> FACILITY <br /> 1D # RECORD ID # <br /> Please Mark the Appropriate Description and Specify S¢e end/or Number of Unit.where ePpli..bl.. <br /> DAIRY PROGRAM {2000} - ,9 -./ , 0) - a-z : <br /> Grads A Decry Otero B Dairy Milk Marne... Number of Containers in Muld-Hand Unit <br /> Food PROGRAM {1600} <br /> Restaurant I sending Capacity 1 9.tl...Footage Produce Stand Ice Plant <br /> I Dry stmnga may 1 w11M1 Fred <br /> Proceed." —� Vending Machines Number of Unit. <br /> Commissars <br /> Retail Market I Squats Footage 1 whir Men,Merkin only I witb Fact Prnparadan I Dry gond.oNy <br /> 1 Make I VeNele Type I color I Ragl.b.don! I U.....! <br /> Food Vehicle I 1 1 1 I <br /> Make I Vebiale Type I Color I Ragiatredmr A 1 Uaenee ifMobile Food Unit t I f i I <br /> Temporary Food Facility Special Event <br /> Dr..of OPernr.c horn to Dania of Operadon ham to <br /> HAZARDOUS WASTE PROGRAM (2200) <br /> 1 Tone ga....led per yaer <br /> Hazardous Waste Generator <br /> Tiered Permit Facility <br /> 1 Cetegoorelly ewho'r.d i Cat.,vab Nlv E.empt Permit by anis <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700) <br /> Hotel/Motel I Number of Units Number of DnploYeea Dairy Employee Housing <br /> App,oxlrnme Data.or oaoapanpy <br /> Jail or Exempt Institution to <br /> LIQUID WASTE PROGRAM {4200) <br /> Pumper Vehicle I Regiete.r."A 1 Ueen.e A 1 C....IH 1 vehicle! <br /> Pumper Yard =1 Package Treatment Plant Chemical ToiletsNmnber of ones <br /> MEDICAL WASTE PROGRAM (4500) <br /> L <br /> rCare Acute Care Skilled Nursin Lar a Generator <br /> ll Generator Transfer Station Limited Hauler Veterinary Clinic <br /> mon Storage Facilityj 2-10 generator. tt-6o g.n.rat.,, >60 gen•remr. <br /> RECREATIONAL HEALTH PROGRAM {3600) <br /> Pool= I Spa Out of Service Pool/Spa Natural Balhirdi Area <br /> Nunba,of Pool./Sps. .1 Facility Pool/Spa ID A <br /> SITE MITIGATION PROGRAM {2900) <br /> Environmental Assessment UST/CAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site i Cel EPA-RWOCB I Cal EPA-DTSC 1 US EPA <br /> 1 NK Site 1 Water ouslity,Site I Other <br /> SOLID WASTE PROGRAM (4400) <br /> Landfill Transfer Station Ag/Cannery Ag/CanneryWaste Site <br /> CIA Landfill Site Sludge/Ash Site Compost Facility Refuse Vehicles Nmnb.,of Unit. <br /> Waste Tire Facility Process/Recycle Facility Dum stere >20 cu d <br /> Nmnb.,of wat. <br /> VECTOR CONTROL PROGRAM {4000) <br /> Poultry Farm Maximus Number or Bird. Kennel _ <br /> Emergency Nodacedinn for this FACIUTY and/or PROGRAM Day Nipht <br /> CONTACT PERSON: IZJSI ZZ7— 1j/ 1 1 <br /> Designated Dnployae F Pmgmm Bement Ale 7Cur t Sc Number of Univ �AD 0 <br /> q <br /> eaalve y net. Reviewed by Data Aaa.u.dcg Office on. Unit Clark On'. Unat Staff Do,. <br />