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-Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Docs the business handle Hazardous Material? Yes {� No [] <br /> a. Type: Q n/-f .4etaary <br /> b. Amount: <br /> 2 Does the business generate Hazardous Waste? Yes No [] <br /> a. Type: A/( eC3�N¢�a�c Sole i1> n clfefwsem, 0 <br /> b. <br /> POrAmount oe e5;�r�y d r pe 9u iP M b P <br /> frtodh. <br /> c EPA#:*Td d6�Gr.� 1Y1e7 ew� EPR <br /> d. Storage method and time stored on premise: <br /> e. Waste disposal method: <br /> 3. Is the business presently under any Permits? Yes [ ] No [] <br /> a. State Permit #: <br /> b. CRWQCB Discharge Requirement #: <br /> C. County Permit#: ISP ogrlm t� <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. to Septa <br /> PI Santfati" on Permit #: <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit#: <br /> 5. 'Type of Water Supply <br /> a. Name of Me H30 System <br /> b. Private Well <br /> PIISIEHD-WeU Permit #: <br /> Number of Employees: f1ClYMtirx <br /> Distance from septic system(s): <br /> Distance from septic system(s): <br /> Distance from Underground Storage Tank: <br /> Distance from Hazardous Material Storage: <br /> Distance from Hazardous Waste Storage: <br /> EH 32 aaS (Pc+V90) <br />