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SAN JOAQUIN LOCAL HEALTH DISTRICT a 1177 ` <br /> � <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1. Does theusi�ness handle Hazardous Material? <br /> a. Typ0%/siavx.� / • <br /> b. Amount N ""', — �' �iC� I V <br /> 2. Does the business generate Hazardous Waste? <br /> a. Type IZ57o-� <br /> b. Amount generated per month <br /> C. EPA # <br /> d. Storage method and time stored on premise aS Gx <br /> e. Waste disposal method. <br /> 3 . Is the business presently under any Permits? <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 /> Private Septic <br /> Under Sanitation Permit # 5-a--7,?- <br /> b. Public Sewer <br /> Name of System <br /> City Discharge Permit # <br /> 5. T7�e of Water Supply <br /> a: Public <br /> �/ Name of System <br /> b. Private Well Permit # <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 /> EH 00 10 ( 4/86 ) <br />