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� T <br /> SJ COUNTY PHS-ENVIRONMENTAL HEALTH❑MSI MASTERFILE; INFORMATION FORM(Eli 00 69(Rarlsod 61941) <br /> Na•w EH PrograinlExisting Facility New EH ProgfelnlNew Facility ❑ate <br /> StIADEL7 SECTIONS FOR LOCAL USE ONLY <br /> f..... <br /> F.; <br /> -�ACILITY:,ID.�k::...... REcaiip IG] <br /> Please Mark the Appropriate Description and Specify Size andlor Number of Units where app[icabia: <br /> DAIRY PROGRAM {2000} <br /> Greda A Dalry Greda B Dairy Milk Dlspenser Numbat of ContalnarT In Muld•Hund Vnit <br /> POOP PROGRAM {1600} <br /> I Santing Capaclty I squnra Footnga <br /> Restaurant I Produce Stand Ice Plant <br /> Dry Storogo only r wltlr Food PreparndonNumber of Unita <br /> Coninliss I I Vendin Machines <br /> 1 Square Footagef wltlr Mont Mcrknt only I -lili Food Praparation I Ory Goode only <br /> Retail Market <br /> 1 Mnko 1 Veldclo Typo 1 Calor 1 Regletratlon# I Uneneg 9 <br /> Food Vehicle 1 I 1 1 1 <br /> 1 <br /> Mobile Food Unit Mnke I Volilcle Type I Color 1 Ragletration# I Ucanse p <br /> I I 1 1 1 <br /> Temporary Food Facility Special Event t <br /> Da[aa or Operation froin to Dotal of OPeradon from to <br /> HAZARDOUS WASTE PROGRAM {2200} <br /> ITone 4nner per n nd year <br /> ! P <br /> Hazardo <br /> us Waste Generator <br /> Categorloally authorizod f Catagorloally Exempt Permit by Rule <br /> Tiered Permit Facility <br /> HOUSING PROGRAM {2400} EMPLOYEE HOUSING {2700} <br /> I Number of Unite Nulnbar of BnPloyeee Dnlry rinpinyos Houalno <br /> Hotel Motel <br /> Appmxknate bates of Oouupenoy <br /> Jail ar Exempt Institution to <br /> Limit) WASTE PROGRAM {4200} <br /> I Ragistrndon A 1 Ucansn A r Capacf[y I Vah[c1e A <br /> Pum er Vehicle <br /> r <br /> Pumper Yard Package Treat merit Number of Units <br /> t Plant Chemical Toilets r <br /> MEDICAL WASTE PROGRAM {4500} <br /> Primary Care Acute Care Skillet! Nursing Large Generator <br /> Small Generator Transfer Station Limited Hauler Veterinary Clinic <br /> (',on3nlOn $LRCSa Facility 2-10 ganarotore l i-60 gonorntors ]60 ganaraton <br /> RECREATIONAL HEALTH PROGRAM {3600} <br /> Peal <br /> spa Out of Service Pool[S a Natural Bathin Area <br /> PdblS...P I❑+P <br /> P <br /> P <br /> Otis ss et Foalll .......,..... ............................... ...................................... <br /> Numtor of oa 1 <br /> ................ <br /> SITE MmGATIUN PROGRAM {2900} <br /> Environmental Assessment I USTICAP Local Haz Waste Haz Mat Pipeline <br /> Other Lead Agency Site 1 Cet EPA-RWOCB 1 Cel EPA-DTSC 1 US•EPA <br /> 1 NPL Sha I W.I.,4uslity Slto I Other <br /> SOLID WASTE PROGRAM {4400} <br /> .._ <br /> >: <br /> ''':1 �:::'{ <br /> ............ ........ .... ...... <br /> Landfill Transfer Station A 1Canrter Waste Site <br /> CIA Landfill Site SludgelAsll Site Compost Facility Refuse Vehicles Number of Wits <br /> Waste Tire Facilit ProcesslRec cle Facilit ! > ''` ' '...... pum stars ]2f]cu d "r"°be'of units <br /> z >:>:.•. <br /> VECTOR CONTROL PROGRAM {4000} L11,02- LC& $3 0D T ,,J 0 . v a,G q 3 <br /> Maximum Number of 61rds <br /> POWILTy Farris [a Kennel <br /> Cmargenoy N.Oficatfon for thio FACILITY andlor PROGRAM Day Night <br /> CONTACT PERSON: { f t ) <br /> f3eaignrifed,GY1p[9yae.. ::''?' .'$<;::; .•'!;p(OQti11n;F7Atf1B11 ... . Ciu ro��Srnlus: Number of L1i;?le :.EPA ID s....!i::;. .. .. ... . <br /> .. :- <br /> F . <br /> aa nro <br /> 3 .:. 9g� np;c..C�a Gn[l nit Of [ �Jld nzl ' nti�` <br /> / { <br />