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i <br /> SAN JOAQUIN LOCAL IICALTH DISTRICT <br /> RNVIRONMENTAL IEALTH DIVISION <br /> Business License SurveyG (/i✓►�v`�— <br /> SL� <br /> 1. Does the business handle hazardous Material? <br /> a. Type ---- <br /> b. Amount <br /> 2 . Does the business generate Hazardous Wa to? 'F41� <br /> a. Type Gi/�e 3 S�--Q < / /L�v� d c-F / Z S;� <br /> b. Amount generated per month <br /> C. IPA It <br /> d. Storage method and time stored on premise <br /> e. Waste disposal method. <br /> 6/, 0 , i <br /> 3 . Is the business presently under any Permits? <br /> a. State Permit It <br /> b. CRWQCB Discharge Requirement It <br /> c. City Permit It <br /> d. County Permit #f <br /> e. Other <br /> A . Type of sewage disposal system <br /> a Private Septic <br /> Under Sanitation Permit I� <br /> b. Public Sewer <br /> Name of System <br /> City Discharge Permit It <br /> 5 . Type of Water Supply <br /> a. Public <br /> Name of System <br /> Db Private Well Permit <br /> Number of Employees <br /> Distance from septic system( s ) <br /> Distance from Underground Storage 'rank <br /> Distance from Hazardous Material Storage <br /> Distance form Hazardous Waste Storage <br /> EH 00 10 ( 4/86 ) <br />