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r r <br />IZI <br />SAN JOAQUIN LOCAL IEALTH J <br />DISTRICT � <br />ENVIRONMENTAL HEALTH DIVISION <br />Business License Survey <br />1• Does the business handle Hazardous Material? <br />a. <br />Type � -------- <br />1 <br />Lv pst.� o -r' q Q Sd <br />b • Amount �� � � yj2U►�� O� <br />2• Does the business generate Hazardous Waste? <br />a. Type e. <br />- <br />b• Amount generated per month q <br />c • EPA # 5 �/ C;(�'�'��; <br />d• Storage method and time stored on <br />e• Waste disposal method. Premise <br />3• Is the business <br />presently under any Permits? <br />a• State Permit # IVO <br />b• CRWQCB Discharge 9 Requirement <br />c• City Permit # NO <br />d• County Permit #N <br />0 <br />e. Other13 u &-� rn2a--7 -gc <br />4• Type of a sews <br />g disposal system <br />a• Private Septic L-� <br />Under Sanitation Permit g <br />b• Public Sewer <br />Name of System <br />City Discharge Permit # <br />5• Type of Water Supply <br />a• Public 4,� <br />Name of System <br />b• Private Well Permit <br />Number of Employees <br />Distance from septic systems) <br />Distance from Underground Stora <br />Distance from Hazardous ge Tank <br />ral <br />Distance form Hazardous Waste1Storageage <br />EH 00 10 (4/e6) <br />