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JAN JUAO U1N LUCA HE/ U1SiRICT <br /> ENVIRONMENTAL HE LTH Df-VISION <br /> Business Licence Survey <br /> 1. Does the business handle Hazardous Material ? A)IA- <br /> a. Type <br /> b. Amount <br /> 2. Does the busi ess generate Hazardous Waste? A-)1A <br /> a. Type <br /> b. Amount ge erated per month. <br /> c. EPA # <br /> d. Storage m thod and time stored on premise. <br /> e. Waste dis osal method. <br /> 3. Is the business presently under any Permits? AJIA <br /> a. State Permit # <br /> b. CRWQCB Di charge Requirement # <br /> c. City Permjt # <br /> d. County Pe it # <br /> e. Other <br /> 4. Type of sewag disposal system. <br /> a. Private S ptic ✓ <br /> Under Sanitation Permit # <br /> b. Public Se er <br /> Name of Sy tem <br /> City Disch rge Permit # <br /> 5. Type of Water Supply <br /> a. Public <br /> Name of S stem <br /> b. Private W 11 Permit # <br /> Number of Employees <br /> Distance rom septic system(s) 2� t <br /> Distance rom Undergroung Storage Tank N�� <br /> Distance from Hazardous Material Storage A11,4 <br /> Distance from Hazardous Waste Storage ^11A <br /> 4-18-86 <br /> RLV <br />