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Public Health Services of San Joaquin Count <br /> Environmental Health Division <br /> DUSMESS LICENSE SURVEY <br /> I• Does the business handle Iluzardous MaterW? <br /> vc'`=•�'�'`� / Yes [ No [) <br /> T)'pe: C <br /> mac'' �:�--L-•..�.� fn,r�, cam.--�i-/ oc. <br /> b. Amount: s <br /> c_ <br /> 2• Does the business generate )Flazardous Syp —� <br /> Yes [ ) No [ ) <br /> a Type: <br /> b• Amount generated per month: S - w �Q_ . <br /> C. <br /> d. Storage method and time stored on premise: -c <br /> e. Waste disposal method: i'ec_ c (fc <br /> �C <br /> 3. Is the business presently under any Permits? <br /> Yes [ ) No [) <br /> a• State Permit # <br /> b. CRW= Discharge Requirement # <br /> C. County Permit# <br /> d• Other. <br /> 4. Type of <br /> sewage dis- — m <br /> a• te Septic$yS�ro <br /> DSanitation' <br /> Permit #: <br /> b Public Scwtt <br /> Name of System: <br /> City Discharge Permit# <br /> 5• Type of Water Supply <br /> a. Name.ouputie'# q System: <br /> b. <br /> tISIV:D <br /> Well-11 <br /> crmlt #: <br /> i <br /> Number of Employees: <br /> Distance from septic system(s): <br /> Distance from septic system(s): l o J <br /> i <br /> Distance from Underground Storage Tank.- <br /> Distance <br /> ankDistance from Haratdous Material Storage: <br /> Distance from Hazardous Waste Storage: <br /> EH 22 ms (nE.X90) i <br />