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r , <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1 , Does the business handle llazardous Material? <br /> a /J <br /> , Type :i o/fM /"-) essc41',-20-1 ac <br /> b Amount /°r°lon... e4l P-72- as <br /> 2, Does the business generate Hazardous Waste? <br /> a, Type C4k Oi/ AOA -Pr �yti C/PG4ly e�an�ir <br /> r J <br /> b. Amount/,5i9 <br /> per month S7d� W.p <br /> C. EPA I <br /> d. Storage method and time stored on premise — OorA6 Gowtcew <br /> e. Waste disposal method. /1or <br /> 3 . Is the business presently under any Permits? <br /> Fl , State Permit # <br /> b. CRWQCB Discharge Requirement I <br /> C. City Permit q <br /> d. County Permit N ,gvlle , A <br /> e. Other <br /> 4 • Type of =eS <br /> disposal system <br /> a . rivpL•ic <br /> Under Sanitation Permit fl ,VO�4 <br /> b. Public Sewer <br /> Name of System <br /> City Discharge Permit M <br /> 5 . Type of Water Supply <br /> a, Public <br /> Name of S stem <br /> Private Wel Permit p 85- 33$ <br /> U er of Employees �3 <br /> Distance from septic system( s ) <br /> Distance from Underground Storage Tank Iv-s1 <br /> Distance from Hazardous Material Storage /S-O ' 4' <br /> Distance form Hazardous Waste Storage ' <br /> Ell 00 10 ( 4/86 ) 1ywl - fes c, - <br />