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11 <br /> ✓ SAN JOAQUIN -LjCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1• Does the business handle Hazardous Mater , <br /> a. Type Gl/rc 5�'.� ial_?� �—y <br /> b Amount <br /> 2• Does the business generate 11azardous Wastc? <br /> a. Type „,/ u s-7�e a-c.( �- Z2,�'`�uoG��-..�, a✓G� <br /> b• Amount generated per month <br /> c• EPA # <br /> d• Storage method and time stored on <br /> e• Waste disposal method. Premise ,� L°'e f�c� <br /> 3• Is the businesspresently ��� <br /> under any Permits? <br /> a• State Permit # <br /> b• CRWQCB Discharge Requirement <br /> quirement � <br /> c• City Permit p <br /> d• County Permit <br /> e• Other -�Iu KX-L4 "c c(—Pu e_ <br /> g• Type of sewage disposal system <br /> a• Private Septic <br /> Under Sanitation Permit <br /> b• Public Sewer •—� <br /> Name of System <br /> City Discharge Permit # <br /> S• <br /> Type of Water Supply <br /> a• Public _� <br /> Name of System <br /> b• Private Well Permit <br /> Number of Employees S <br /> Distance from septic systems ) <br /> Distance from Underground Stora e <br /> Distance from Hazardous g Tank <br /> Distance fMaterial Storage <br /> orm Hazardous <br /> Waste Storage <br /> EH 00 10 (9/06) <br />