Laserfiche WebLink
blit Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Material? 9 Yes (t� No [ ] <br /> a. Type: <br /> b. Amount = S SgG,r /z4C vw S C' /izell? <br /> 2 Does the business generate Hazardos Waste? Yes (� No [] <br /> a. Type: Wa 5& O I <br /> b. Amount generated per month: cl., / � C,��A <br /> C. EPA#: <br /> d. Storage method and time stored on premise: /V o LvnSG`' ON Al' o f f/nre' C" <br /> C. Waste disposal method: ((A/05t' o / {eh,+n,,•�Gr 1 e. /F�,S 4-/ &,Xr 7 o <br /> 3. Is the business presently under any Permits? Yes ( ] No [] <br /> a. State Permit #: <br /> b. CRWQCB Discharge Requirement #. N fI <br /> C. County Permit#,. LL <br /> d. Other. Tn [, <br /> 4. Type of sewage disposal system <br /> a. Private Septic System <br /> PIIS/EIID Sanitation Permit #: <br /> b. Public Sewer <br /> Name of System: r C) > Srwe �ua•Y _ _ <br /> City Discharge Permit#, ' <br /> 5. Type of Water Supply <br /> a. Name of Pulie Hyo System <br /> b. Private Wcg <br /> PI-IS/EHD Well Permit #: <br /> Number of Employees: <br /> Distance from septic system(s): <7 <br /> Distance from septic system(s): ^"4 <br /> Distance from Underground Storage Tank 1,.).4 <br /> Distance from Hazardous Material Storage: 1,/W <br /> Distance fromHazardous Waste Storage: <br /> EH 73 035 (M V") •. <br /> ;ZI�Iv, S Zc ns. � :Gf N�� <br /> G O'N Yrr�vr'. w• <br />