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Public Health Services of San Joaquin County <br /> '1J,m jy( 2'q Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> b <br /> 1.tfi(e/'Does the business handle Hazardous MatrrW' ? Yes [t}/ No (] <br /> y� p-11 1n VO bu1K��=96L1 C;� tn¢rto o-� (�,L• q ao{�,' 'K /1�.y`s. <br /> y1a b. Amount: je-Y brli�S � OCs �`� �/1� �1VIVIO ad 6,0 � 1� <br /> 2 Does t e bustncss generate Waste? Yes (!� No [] <br /> (Ever9rcen (Hlg Sl>,rra� �,Y <br /> a. Type: I,�J a sf� o I Ul.D �l I ►s �f R'495 sol vim,+ -� Kl w <br /> I�p �t b. Amount generated per month: ^2nd a� MD ^'Ub mb <br /> o" t,S e. EP EvP� e a1 LOoDD Z90�or <br /> D� '' ca rtx�o 1398 <br /> Z\ d. Stora a method and time stored on remise:O11 OLS 6yeArou0 '�wr1Y <br /> e�XCTCZ <br /> e. Waste disposal method: <br /> p11` 3. Is the business presently under any Pcrmits? Yes [ ] No ( ] <br /> a. State Permit <br /> b. M%VCCB DisC ;e Requirement <br /> c County Permit <br /> d. Other. 06)0,\ <br /> 4. Type of sewage disposal system <br /> a. Private Septic System I <br /> PHS/EIIID Sanitation Permit 0A <br /> b. Public Sewer\11�5 <br /> Name of System: <br /> City Discharge Permit;# <br /> 5. Type of Water Supply '' <br /> a. Name of Pulic II,.0 System ''_tl e, <br /> b. Private Well <br /> PFIS/EHD Well Permit <br /> Number of Employees I V <br /> Distance from septic system(s): ` 4 <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 n aas CRev v40t <br />