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Public Health Services of San Joaquin County <br /> Environmental health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Material? / Yes (]� No [] <br /> a. Type: �i�f so f,- ,f,G,,1It <br /> b. Amount: 04 ��OiZS <br /> 2 Does the business generate Hazardous Wane? Yes f}/ No (] <br /> a. Type: 4 c/4S1e , /-/ , 50/Il/il <br /> b. Amount generated per month: /5-re Z :Ll/frV75 e o7ssti� <br /> C. EPA#: C,4Z- 000 037 �S 3/ <br /> d. Storage method and timestoredon premise: pi`l a�otX /0011 ✓� rrr �Xft�w1_S <br /> e. Waste disposal method: (/ I L. c4 nfyi �Yly. So I,pK - S�teky <br /> 3. Is the business presently under any Permits? Yes () No (J <br /> a. State Permit #: <br /> CRWQCB Discharge Requirement <br /> C <br /> /// CountvPermit# i'/G G E --Cr� <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> Private Septic System p7 <br /> PHS/EJ-1D Sanitation Permit #: / <br /> b. Public Sewer <br /> Name of System: <br /> City Discharge Permit# <br /> S. Type of Water Supply <br /> a. Name of Pulic 1Iz0 System <br /> Private Well .. <br /> PHS/EHD Well Permit#: <br /> Number of Employees <br /> Distance from septic system(s): <br /> 2FX� <br /> Distance from septic system(s): z <br /> Distance from Underground Storage Tank C?(V <br /> Distance from Hazardous Material Storage: <br /> Distance from HazardousWasteStorage: �S / <br /> rtt 22 au tai VW) /7�i✓ifio fa �i 5�. C� r+/.crorl�7 <br />