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`: <br />A <br />(50SAN JOAQUIN LOCAL HEALTH DISTRICT 30C3�r1e - a?zff c <br />ENVIRONMENTAL HEALTH DIVISION �•. <br />Business License Survey do bk C0,101;,41 000 f. wlre5er <br />��p <br />1. Does the business handle Hazardous Material? /o"" <br />a. Tyne flrel ltNe� a eri c0 Ino�ar o� -3 4 Q `I <br />r`(� f yOUPjM Qti o <br />b . Amount / f cyv,•,1� exc,�(lk-c 3 d axe Fes+ r , c/ CO2, ma G r (r. 90n <br />2. Does the business generate Hazardous Waste? ypS C�Gers <br />a. Type Wnit o? / po,,,,/� ("C'st.- r f,�riv�rr cry Ifi. <br />b. Amount generated per month I C)O <br />C. EPA # EPA N uv b t t'QE�urrc i 0 <br />d. Storage method and time stored on premise /)0u4(p <br />e. Waste disposal method. o; (-i�cYcl�r,+'. TI,.;,Ne,� y/�aiA wc�sC Ina�'sl*r1' <br />3. Is the business presently under any PermitZ <br />a. State Permit # Cny,,r„ f <br />�,b vs lsira✓ �crrr�**,/�rr►-, S <br />b. CRWQCB Discharge Requirement # ._drs`�"'rG �^�"`� �'uhw,•�� (psi,, <br />e. City Permit # rre <br />d. County Permit #�6 <br />e. Other <br />4. Type of sewage disposal system <br />a.Private Septic Sp�{� -«�{s ; Voy O(X <br />Under Sanitation Permit # <br />b. Public Sewer <br />Name of System <br />City Discharge Permit # <br />5. Type of Water Supply <br />a. Public. <br />Name of System <br />b. rivate W 1 ermit # <br />x ued A -SGS. ,910 <br />y c0 �p 1/5 r / NR w Q9 W # <br />Number of Employees 11'v -yam <br />Distance from septic system(s)/001f <br />Distance from Underground Storage Tank NiF <br />Distance from Hazardous Material Storage ad <br />Distance form Hazardous Waste Storage <br />J <br />EH 00 10 (4/06) <br />6 gi, J r,��►ll�°��' <br />