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t4,44aeA //CUcI- I F-1 <br /> IAN JUAIIUIN LOCAL Ht ALur ) IH11- 1 �7U0 M' l3KoRb } S; J �1 7 <br /> ENVIRONMENTAL HEALTH D1VIION <br /> Business Licence Survey <br /> 1. Does the business handle Hazardous Material ? <br /> a. Type W+� o GP tt S� <br /> b.- Amountr- <br /> 2. Does the business generate Hazardous Waste? <br /> a. Type a a-tP oc <br /> b. Amount generated per month. G•--r--A- <br /> c. EPA M I—, <br /> 4g!�(,� � <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 M <br /> b. CRWQCB Discharge Requirement M <br /> c. City Permit N <br /> d. County Permit N <br /> e. Other <br /> 4. Type of sewage disposal system. c�CM <br /> a. Private Septic <br /> Under Sanitation Permit A <br /> .b. Public Sewer ;P� <br /> Name of System <br /> City Discharge Permit / <br /> 5. Type of Water Supply C <br /> a. Public <br /> Name of System <br /> b. 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 <br /> Sldvii. oGc�.w . '2o-� <br /> 01 <br /> �� GOC' •/��—rrtr7 <br /> r/ <br /> 4-18-86 <br /> `; RLV <br />