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Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY CrI <br /> Allepr <br /> 1. Does the business handle Hazardous Material? &40° Yes [j No [ <br /> a. Type: <br /> b. Amount: <br /> 2. Does the business generate Hazardous Waste? Yes [ No [J <br /> a. Type: O <br /> b. Amount generated per month: A., 250g, <br /> C. EPA#: <br /> d. Storage method and time stored on premise: L Ar)e Q w o &A, MPr_ <br /> e. Waste disposal method: <br /> 3. Is the business presently under any Permits? Yes [] No [ <br /> a. State Permit #: <br /> b. CRWQCB Discharge Requirement <br /> C. County Permit#: <br /> d. Other: <br /> 4. Type of sewage disposal system <br /> a. Private�anitation <br /> mit #: <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit#: <br /> 5. Type of Water Supply <br /> a. Naim of Pulic H20 System: <br /> b. (: <br /> . ppe P <br /> ell 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: 1501 <br /> Distance from Hazardous Waste Storage: <br /> EH 22 WS (Rev 4/90) <br />