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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 3 n- v I - <br /> b. Amount 1 a Cc'- w o'� <br /> 2. Does the business generate Hazardous Waste? <br /> a. Type <br /> b. Amount generated per onth --L 25 <br /> c. EPA # <br /> d. Storage method and time stored on premise <br /> e. Waste disposal method. U `� <br /> 3 . Is the business presently under any Permits? <br /> a. State Permit # <br /> b. CRWQCB Discharge Requirement # <br /> C. City Per it # <br /> d. County Permit # <br /> e. Other <br /> 4 . Type of sewage disposal system <br /> c <br /> ,�� Private Septic <br /> Under Sanitation Permit # <br /> b. Public Sewer <br /> Name of ')ystem <br /> City Discharge Permit # <br /> 5 . Type of Water Supply <br /> a. Public <br /> Name of ystem <br /> b. Private Well Permit # <br /> Number of Employees <br /> Distance from septic system( s) <br /> Distance from Underground Storage Tank <br /> Distance from Hazardous Material Storage <br /> Distance form Hazardous Waste Storage <br /> EH 00 10 ( 4/86 ) <br />