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SAN JOAnUIN LOCAL HEAL JISIRICI <br />ENVIRONMENTAL HEALTH DIVISION <br />Business Licence Survey <br />1. Does the business handle Hazardous pMaterial? <br />a. Type Pq, r,� dz� Y o huzb i (r S <br />b. Amount <br />2. Does the business generate Hazardous Waste? <br />a. Type <br />b. Amount generated per month. <br />c. EPA N <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 k <br />c. City Permit N <br />d. County Permit d <br />e. Other <br />4. Type of sewage disposal system. <br />a. Private Septic <br />Under Sanitation Permit N <br />b. Public Sewer <br />Name of System <br />City Discharge Permit N <br />5. Type of Water Supply <br />a. Public <br />Name of System <br />b. Private Well Permit N <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 />4-18-86 <br />P.LV <br />