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IAN JOAIIUIN LOCAL HLALII, IRILI <br /> ENVIRONMENTAL HEALTH DIVIMN <br /> Business Licence Survey <br /> 1. Does the business handle Hazardous Material? <br /> a. Type ,,,,& P� .S Z ✓?=�� <br /> b. Amounts <br /> 2. Does the business generate Hazardous Waste? <br /> a. Typeo< <br /> b. Amount generated per month. <br /> c. EPA # z--dv� /4<-� <br /> d. Storage method and time stored on premise. <br /> e. Waste disposal method. <br /> 3. Is the business presently under any Permits? <br /> a. State Permit # <br /> b. CRWQCB Discharge Requirement N <br /> c. Citv Permit N <br /> d. County Permit N <br /> e. Other <br /> 4. Type of sewage disposal system. C� <br /> a. Private Septic <br /> Under Sanitation Permit M <br /> b. Public Sewer Tc,,- <br /> Name of System <br /> City Discharge Permit M <br /> 5. Type of Water Supply Z�ncs— <br /> b. <br /> a. Public r C � CVName of ystem Private Well Permit M <br /> Number of Employees <br /> Distance from septic system(s) <br /> Distance from Undergroung Storage Tank <br /> Distance from Hazardous Material Storage <br /> Distance from Hazardous Waste Storage s _Q <br /> 11kL -sus or <br /> 4-18-86 <br /> P.LV <br />