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Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> YEJ/ 13USINFM LICENSE SURVEY <br /> 3 . 2- i <br /> 1. Does the business handle 1lazardous Material? Yes ] No [- <br /> a. <br /> b. Amount: /tom OZ411 <br /> 2. Does the business generate Hazardous Waste? /J Yes I I No 14 --- <br /> a. Type: '%`,1' <br /> b. Amount generated per month: <br /> C. LPA#: <br /> d. Storage method and time stored on premise: <br /> t. Waste disposal method: _ <br /> I Is the business presently under any Permits? Yes [ ] No [ <br /> a. State Permit # <br /> b. CRWQCE Discharge Requirement # <br /> C. County Permit# <br /> d. Other._ 69,0 t. <br /> 4. 'Type of sewage disposal system <br /> H. Private Sepik System <br /> PIISMI:ID Sanitation Permit #: Cif i u c. ti C- <br /> _ <br /> b. Publie Scwtt <br /> Name of System: AV <br /> City Discharge Permit# <br /> 5. Type of Water Supply <br /> a. Name of Putic 11.0 System: <br /> b. Private Wel! <br /> PI-1S/E,I1D Well Permit #: <br /> Number of Employees: <br /> Distance from septic system(s): <br /> Distance from septic system(s): 0� <br /> Distance from Underground Storage TanlL <br /> 17 <br /> Distsnce frons Hazatdous Material Storage: 00 <br /> Distance from)hazardous Waste Storage: /y <br /> VI 2203 (Kkv 4M) <br />