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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 pctz;� wos4-e 7'7a;Y r ear — <br /> b. Amount / S 305wG -3n`O4 <br /> 2 . Does the business generate Hazardous Waste? cyea� <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? A10 <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 DD <br /> City Discharge Permit # <br /> 5 . Type of Water Supply <br /> a. Public <br /> Name of System <br /> b. Private Well Permit # ?Q� <br /> 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 /> /LP,G(j <br /> L��Sce.4,s u, 72eU1 U <br /> E00- 1 4 B6 y <br /> 4' <�/GG�"J <br /> �/IV i : GwLL' ��CiCfznU�a E�, <br /> O SS a' kt/w� L(J�s r' ayvl S c�G o Sd2� ! �c�. /� �o v✓ p <br />