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. I , Health Services of San Joaquin County , <br /> Environmental Health Division <br /> i <br /> BUSINESS LICENSE SURVEY <br /> [iJ [l <br /> t, Does the business handle Hazardous Material? Yes No/ <br /> a. Type: <br /> b. Amount: <br /> 2, <br /> Yes No <br /> Does the business generate Hazardous Waste? <br /> [] <br /> a. Type: <br /> b, Amount generated per month: - �"�� J �� <br /> n v <br /> Z) <br /> G EPA#: ,nj Cj <br /> f' <br /> d. Storage method and time stored on premise: 1 <br /> e. Waste disposal method: d <br /> ce 0p mwe-,,7— G Yes [ No <br /> a [ ] <br /> 3, Is the business presently under any Per <br /> a. State Permit #: <br /> r <br /> b CRWQCB Discharge Requirement #- <br /> C. County Permit#: <br /> ell <br /> d. Other. <br /> 4. 'Type of sewage disposal system <br /> a, Private Septic System <br /> PI-IS/EIID Sanitation Permit #: `^J<] <br /> b. Public Sewer N b <br /> Name of System: <br /> City Discharge Permit# <br /> S. 'Type of Water Supply <br /> a, Name of Pulic H20 System J <br /> b, Primate Wctl <br /> PI-IS/EHD Well Permit #: <br /> Number of Employees: <br /> Distance from septic system(s): <br /> Distance from septic system(s): <br /> Distance from Underground Storage Tank: <br /> Distance from Hazardous Material Storage' <br /> Distance from Hazardous Waste Storage: l�"r <br /> EH 22 035 (Fie+4/90) <br />