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SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1. Does the business handle Hazardous Material? <br /> a. Type <br /> b. Amount (Va,r(jM&6 eA&CLS) <br /> 2. Does the business generate Hazardous Waste? C� <br /> a. Type <br /> b. Amount generated per month <br /> c. EPA # <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 # <br /> C. City Permit # <br /> d. County Permit # <br /> e. Other <br /> 4 . Type of sewage disposal system <br /> a. Private Septic <br /> Under Sanitation Permit # <br /> b. Public Sewer <br /> Name of System <br /> City Discharge Permit # <br /> 5. Type of Water Supply <br /> Public NAV6fio deo- — VurJ2 r <br /> Name of System <br /> Private Well Permit # <br /> �J Number of Employees <br /> Distance from septic system(s) <br /> Distance from Underground Storage Tank <br /> Distance from Hazardous Material Storage <br /> Distance form Hazardous Waste Storage <br /> EH 00 10 ( 4/86 ) <br />