Laserfiche WebLink
• 0 <br /> Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> I. Does the business handle Hazardous Material? Yes No [] <br /> a. 'Type: C I-L– <br /> b. <br /> ✓b. Amount: C) (0 (It) <br /> 2. Does the business generate Hazardous Waste? Yes No [] <br /> a. Type: IAjla.S-f- Ll 1,j2n '- 1��n1 <br /> b. Amount generated per month: 47-ant– <br /> C. EPA#• _ IS Ylf.. V l ICY '_l_►11 tN M( 1�L7 <br /> d. Storage method and time stored on premise: – V71[W-1s <br /> C. Waste disposal method: IZOU4,-,(.94 � '�V1P.rrt t-t 0 46.a SQ <br /> f- <br /> 3. Is the business presently under any Permits? Yes [] No [] <br /> a. State Permit #: <br /> b. CRWQCB Discharge Requirement #: <br /> C. County Permit#: <br /> d. Other: � <br /> 4. Type of sewage disposal system p ?CUJ—a. Private Septic System UU41 `' II `�fO' � <br /> PHS/EHD Sanitation Permit #: t <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit <br /> S. Type of Water Supply 7,Q W <br /> a. Name of Pulic I320 System r' <br /> b. Private Well <br /> PHS/EHD Well Permit#: <br /> Number of Employees: <br /> Distance from septic system(s): <br /> Distance from septic system(s): <br /> Distance from Underground Storage Tank: <br /> Distance from Hazardous Material Storage: (f') <br /> Distance from Hazardous Waste Storage: I I 1 <br /> EH 22035 (Rev 4/90) •. <br />