Laserfiche WebLink
Public Health Services of San Ioaquin County <br /> Environmental Ltealth Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Yes No (] <br /> a. Type:/fit"�O� o/L Baa G-LGlc/ <br /> b. Amount: <br /> 2 Does the business._generate Rm=-dous Wane? YesX No [] <br /> a. Type: d - ,,ZF " -Z <br /> b. Amount generated per month: <br /> C. EPA#: - -,c <br /> d. Storage method and time stored on premise: `-�`� <br /> e. Waste disposal method: /�� ��✓ <br /> 3. Is the business presenq under any Pcrmits? Yes [] No 11-7 <br /> a. State Permit # <br /> b. CRWCCB Disc.,.arge Requirement <br /> C. County Permit <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Priv=Septic System <br /> PHSJEI D Sanitation Permit ; <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit <br /> S. Type of Water Supply <br /> a. Name of Pulic 1I20 System: <br /> b. Private Wed <br /> PHS/EHD Well Permit # <br /> Number of Employees: <br /> Distance from septic system(s): <br /> Distance from septic system(s): <br /> Distance from Underground Storage Tant <br /> Distance from Hazardous Material Storage <br /> Distance from Hazardous Waste Storage: <br /> EH 72 M5 (R"V90) <br />