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SAN JOAQUIN LOCAL HEM.TH DISTRICTS G/qc� <br /> ENVIRONMENTAL HEALTI-.../ISION� H 2 3 7S6'.1'`-*4 <br /> Business Licence Survey ��,C` <br /> 1. Does the business handle Hazardous Material? u�J <br /> a. Type <br /> b. Amount «o <br /> 2. Does the business generate Hazardous Waste? <br /> a. Type <.._z, <br /> b. Amount generated per month. <br /> c. EPA # <br /> ml <br /> d. Storage method and time stored on premise, u '�{ � 3H " <br /> e. Waste disposal method. cam <br /> 3. Is the business presently under any Permits? <br /> a. State Permit # fit- 41 e� 134-aA-. aa,`o --6-6 ky` <br /> b. CRWQCB Discharge Requirement # <br /> c. Citv Permit # <br /> d. County Permit # :ate; foi . Gru .a �c ��sc <br /> e. Other VV / <br /> 4. Type of sewage disposal system. <br /> ,✓a. Private Septi c �t S <br /> Under Sanitation Permit # <br /> b. Public Sewer /Jc <br /> Name of System <br /> City Discharge Permit # <br /> 5. Type of Water Supply <br /> a. Public A/o <br /> Name of System <br /> b. Private Well Permit # <br /> Number of Employees e- � p 471' Z j°fad <br /> Distance from septic system(s)��nU FT. <br /> Distance from Undergroung Storage Tank N//+ <br /> Distance from Hazardous Material Storage r Soo fT. <br /> Distance from Hazardous Waste Storage !o0 FT. <br /> 4-18-86 <br /> RLV <br />