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• <br /> r <br /> SAN JOAQUIN LOCAL 11EALTH DISTRICT <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Business License Survey <br /> 1. Does the business handle Hazardous Material? 0. Rtl <br /> a. Type vto <br /> b. Amount <br /> 2 . Does the business generate Hazardous Waste? <br /> a <br /> a. Type (/v, 0 . <br /> - ��J � Cy(S)9&-7 <br /> b. Amount generated per month wZ y 4 <br /> c. EPA � <br /> d. Storage method and time stored on premise o <br /> e. Waste disposal method . q, S, Zf)a �� d-iiL <br /> 3. Is the business presently under any Permits? <br /> a. State Permit # <br /> b. CRWQCB Discharge Requirement N �;� <br /> c. City Permit N <br /> d. County Permit N <br /> e. Other <br /> 4 . Type of sewage disposal system <br /> a. Private Septic u " <br /> Under Sanitation Permit N <br /> j b. Public Sewer <br /> Name of System <br /> City Discharge Permit N <br /> j 5 . Type of Water Supply <br /> a. Public <br /> Name of System <br /> b. Private Well Permit fl <br /> Number of Employees S- 7� <br /> Distance from septic system(s ) <br /> Distance from Underground Storage Tank ��''"""' <br /> Distance from Hazardous Material Storage ivwu <br /> Distance form Hazardous Waste Storage <br /> flC� �a S67 7La 5.5at <br /> EH 00 10 ( 4/06 ) <br /> � �'83 � A�r� P ► � <br />