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93 93 <br />4. <br />S. <br />Public Health Services of San Joaquin County <br />Environmental stealth Division <br />BUSINESS LICENSE SURVEY <br />Does the business handle T azardo s Material? <br />a. <br />a <br />Yes.No [ ] <br />a44 <br />4� <br />M25 <br />Does the business generate Hazardous Waste? Yes {,}� No [ ] <br />a. Type: C� G OCL <br />b. Amount generated per month: `5�0 64AedA-12:- <br />e. EPA #: <br />d. Storage method and time stored on premise: /Qi17✓L '4��+13/`1l� 7✓�I'f��-�3� ��� l5G''� ��'QvM <br />e. Waste disposal method: Gf/�f cNf7(�orclh �L <br />Is the business presently under any Permits? Yes No [ j <br />a. State Permit #: <br />b. CRWQCB Discharge Requirement <br />C. County Permit-jy-' Ff�� <br />CL Other. <br />Type of sewage disposal system <br />C_. Private Septic System <br />PHS/EIID Sanitation Permit #: <br />b. Public Sewer <br />Name of System <br />City Discharge Permit #: <br />Type of Water Supply <br />a. Name of Pulse H1O System: A, <br />Cb-7� Private Well . <br />PHS/EHD Well Permit #: <br />Number of Employees: 7 (.I <br />Distance from septic system(s): <br />Distance from septic system(s): fq(> <br />Distance from Underground Storage Tant <br />Distance from Hazardous Material Storage: <br />Distance from Hazardous Waste Storage: <br />ntnau (� v ) <br />