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Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Material? Yes , No [ j <br /> a. Type: <br /> b. Amount: <br /> 2 Does the business generate Hazardous Waste? Yes No [] <br /> a. Type: <br /> b. Amount generated per month: <br /> c. EPA#: ALJ n I w%✓�!' moi! G fL�f� �'�'w __ -- �__ // <br /> d. Storage method and Lime stored on premix: &PI <br /> e. Waste disposal method: .t+ / '114 f v <br /> 3. Is the business presently under any Permits? U_ Yes [ ] No (] <br /> a. State Permit #: <br /> b. CRWOCB Discharge Requirement #: <br /> C. County Permit#: <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Private Septic System <br /> PHS/UID Sanitation Permit # <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit#: <br /> 5. Type of Water Supply <br /> a. Name of Pulic 11z0 System: <br /> b. Private Well )/ <br /> PHS/EHD Well Permit #: <br /> Number of Employees ��� 2421 in ll4 A/0-4 <br /> Distance from septic system(s): <br /> Distance from septic system(s): <br /> Distance from Underground Storage Tanlc <br /> Distance from Hazardous Material Storage: <br /> Distance from Hazardous Waste Storage: <br /> EN 21 Cis (aw V") <br />