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4P <br /> Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Material? Yes,T No [ j <br /> a. Type: /�l�r��./�/rf'rF- <br /> b. Amount: <br /> 2 Does the business generate Iftmrdous Waste? Yes No [] <br /> a. Type: 0,451-25- I?'�'�.�/�f7nT� 03;,Z- <br /> b. <br /> s/b. Amount generated per month: .f�c✓'' �A/c:� lt1 /d` °Tf�'LS'Ts,�t� <br /> C. EPA#: z:54C/- DlreIN4-4 .T�/FD c2,y ic,P,4. x1 <br /> d. Storage method and time stored on premise: owV� <br /> e. Waste disposal method: Ol'L CZ:9± S/Y <br /> 3. Is the business presently under any Permits? Yes [] No _bj�7 <br /> a. State Permit #: <br /> b. CRWQCB Discharge Requirement # <br /> C. County Permit#: <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Private Septic System <br /> PHS/EHD Sanitation Permit #: S T� � ��tlS � 6� Vl--' Ar4Y <br /> b. Pubfie Sewer AA <br /> Name of System: <br /> City Discharge Permit#: <br /> S. Type of Water Supply <br /> a. Name of Pulic H;,0 System: GL--G lf�S/'T� <br /> b. Private WeU I <br /> PHS/EHD Well Permit#: <br /> Number of Employees: <br /> Distance from septic system(s): ,t11A <br /> Distance from septic system(s): 'G�Q <br /> Distance from Underground Storage Tank: <br /> Distance from Hazardous Material Storage: <br /> Distance from Hazardous Waste Storage: <br /> EH 22 035 (Rev 4/90) <br />