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/ lic Health Services of San Joaquin County • <br /> FnvironmcnW Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous <br /> MatcriLal? �r Yes V No [ J <br /> a. Type: <br /> b. Amount: <br /> 2 Does the business generate Ilarardotu Wave? Yes (] No [ ] <br /> a. Type: W q5e, Oil [tel o rt� S <br /> b. Amount generated per month: W <br /> 0 <br /> C. EPA#: <br /> d. Storage method and time stared on premise: <br /> C. Waste disposal method: <br /> 3. Is the business presentty under any Permits? Yes [ ] No [ ] <br /> a. State Permit #: <br /> b. CRWOC13 Discharge Requirement #: <br /> C. County Permit#: <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Private Scok System <br /> PHSIEHD Sanitation Permit #: <br /> b. Public <br /> ame System: «f �? �`r?X,lf���/�✓ <br /> City Discharge Permit#: <br /> S. Type of Water Supply <br /> a. Name of PuBc H30 System: <br /> b. Private Well <br /> PHS/FHD Well Permit #: <br /> Number of Employees: <br /> Distance from septic system(s): <br /> Distance from septic system(sg <br /> Distance from Underground Storage Tank: <br /> Distance from Hazardous Material Storage: <br /> Distance from Hazardous Waste Storage: <br /> trtaaas ln�+wo) •• <br />