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Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS I ICENSE SURVEY <br /> 1. Does the business handle FTztzardo s Matrsial? Yes [Lj� No (] <br /> a. Type: 5oI ve r �I m 0+n r bl draJ4 i(d <br /> b. Amounc!!� 04ICQat cwQ < 5�0.Q PAl4Akzut.rJ.. oV.sl{k f, <br /> Z Does the business generate Hazardous Waste? Yes [] NO (] <br /> a. Type: L000k I (3)GO <br /> b. Amount generated per� GctQ , { u <br /> C. EPA + CRL- Moo Z ? eq�f 'Alov <br /> d. Storage method and time <br /> ''stared <br /> �on premise I�SS�a lCan 1�MeS� - N L..fl7l <br /> e. Waste disposal method W"��-�� — N Ieua a .�� `'IRxX2�-, <br /> 3. Is the business presently under any Permits? Yes (] No <br /> a. State Pert nit # �� <br /> b. CRWQCB Discharge Requirement �U <br /> C. County Permit# <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Prim Septic System ��5 <br /> PHS wn Permit it <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit ak <br /> S. Type of Water Supply <br /> a. Name of Pulic 1-I20 System: <br /> b. ��� <br /> Well Permit #: <br /> Number of Employees 2 <br /> Distance from septic system(s): <br /> Distance from septic systems} <br /> Distance from Underground Storage Tanlc <br /> Distance from Hazardous Material Storage,. <br /> Distance from Hazardous Waste Storage: <br /> nt a au at"vcn) <br />