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�. ublic Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Rfaterial? GD422-t -t1' 0�QrCZU Z_ Yes � No [ ] <br /> a. Type: �) ^( S �D �( CL25 �ti9GyQ /l 4. <br /> a <br /> b. Amount <br /> 2 Does the business generate Hazardous Waste? Yes ( ] No ( ] <br /> a. 'Type: t t !f I s z IgL�C <br /> b. Amount generated per month: <br /> C. EPA#: <br /> d. Storage method and time stored on premise: <br /> e. W Sted�ethod. � Q/ L c� <br /> 3. Is the business presently under anyYEttSits? Yes ,fy No (] <br /> a. State Permit #: <br /> b. CRWOCB Discharge Requirement <br /> C. CountyPermit#:y� 11�1 <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Private Septic System <br /> PHSIERD Sanitation Permit # I/ <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit#- <br /> S. Type of Water Supply <br /> a. Name of Pulic HO System: <br /> b. Private Wcll <br /> PHS/?-HD Well Permit#: <br /> Number of Employees: <br /> Distance from septic system(s): ti a 7 r' 3QG� <br /> Distance from septic system(s): // <br /> Distance from Underground Storage Tanlc V� A /�L�b'Dy)y7e /K <br /> i <br /> Distance from Hazardous Material Storage: "tai 300 35-d <br /> Distance from Hazardous Waste Storage: <br /> w n ttu (tt�.vara <br />