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s . <br /> SAN JOAQUIN LOCAL HEALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1. Does the business handle Hazardous aterial? ,-a' <br /> r�, M � ycD� <br /> a. Type <br /> b. Amount <br /> 2. Does the business generate Hazardous Waste? <br /> a. Type <br /> b. Amount generated per month <br /> c. EPA # <br /> d. Storage method and time stored on premise . e <br /> e. Waste disposal method. ��// GC G G'C1Y14 <br /> rJII� C <br /> 3. Is the business presently under any Permits? <br /> a. State Permit # <br /> b. CRWQCB Discharge Requirement # <br /> c. City Permit # <br /> d. County Permit # <br /> e. Other ��� �/ Cc'i72C� <br /> —7 4 . Type of sewage disposal system <br /> a. Private Septic y z,50 <br /> Under Sanitation Permit # GI <br /> b. Public Sewer <br /> Name of System <br /> City Discharge Permit # <br /> 5. Type of Water Supply <br /> a. Public <br /> Name of System <br /> b. Private Well Permit <br /> Number of Employeesr <br /> � S di Cv <br /> Distance from septic system( s ) <br /> Distance from Underground Storage Tank 1?'),-, _• <br /> Distance from Hazardous Material Storage c2o �zofsfa . <br /> p ,Y� Distance form Hazardous Waste Storage /Ub Sri <br /> ' " ��CG <br /> EH 00 10 ( 4/86 ) <br />