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h <br /> Y <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1, Does the business handle Hazardous Material? <br /> a. Type Oaf A-A solve bf4mull� <br /> b Amount l,69 f"'•~� -fkw j0- zs-�aQ <br /> 24 Does the business generate !Hazardous Waste? - <br /> a. Type c,t��sYc ,6,.�✓prr�s 5a/�P.�� Q --<;:,/ 1<'k-Y.1 <br /> b. Amount generated perm R dre �Tt5jL �e rru,r�C <br /> c. EPA #c4/tvpovo-*/jc !tuck Alas4 ew-k also ox1 s•`a <br /> d. Storage method and time stored on premise _ A[rnx� �'9u� °'asci <br /> e. Waste disposal method. Wkt3, Is Is the business presently under any Permits? i <br /> a. State Permit # <br /> b, CRWQCB Discharge Requirement # <br /> C, City Permit f Fee AVV, rn,,, �1-715-7 <br /> d. County Permit # <br /> e. Other osf 4 rr'-M,/ <br /> 4 . Type of sewage disposal system <br /> a, Private Septic <br /> Under Sanitation Permit II <br /> Public sewer 1 <br /> Name stem <br /> City Discharge Permit # <br /> 5, Type o ter Supply <br /> . Public <br /> System <br /> b, Private We 11 Permit # } <br /> Number of Employees--S I <br /> Distance Brom septic system(s ) <br /> Distance from Underground Storage Tank NO A�Q N� f <br /> Distance from Hazardous Material' Storage NA <br /> Distance form Hazardous Waste Storage <br /> F; s�vec yISI'7p <br /> t <br /> Q <br /> EH 00 10 ( 4/06 ) <br /> - 'i <br />