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Public Health Services of San Joaquin County <br /> Environmental Health Division <br /> BUSINESS LICENSE SURVEY <br /> 1. Does the business handle Hazardous Matcrial? Yes No [ ] <br /> a. Type:_ _A5Z05LV6- <br /> b. Amount: a�p/J�cz Z SS G41- <br /> 2. <br /> ,aL2 Does the business generate Hazardous Waste? Yes [] No [] <br /> a. Type: 4GQ41- O f L <br /> b. Amount generated per month: 4ioo C-AL- 1,14tU N7-4 <br /> C. EPA# 4//L1, 4QvG2Eytoot f cwSE of ascC-ocJ <br /> K <br /> d. Storage method and time stored on premise: 5O4, GsfL t SF4-4 J GMDE <br /> e. Waste disposal method:_ rrnr�� AOwra <br /> 3. Is the business presently under any Permits? Yes [] No [� <br /> a. State Permit #: <br /> b. CRWOCB Discharge Requirement #: <br /> C. County Permit#: <br /> d. Other. <br /> 4. Type of sewage disposal system <br /> a. Private Septic System <br /> PHS/EHD Sanitation Permit # <br /> b. Public Sewcr <br /> Name of System: GIr—y or 57JG /LTo/�I <br /> City Discharge Permit#: 2 <br /> 5. Type of Water Supply <br /> a. Name of Pulic H10 System: e (CT—Y OF ST7��-KTa1�� <br /> b. Private Well <br /> PHS/EHD Well Permit#: <br /> Number of Employees: �! <br /> Distance from septic system(s): <br /> Distance from septic system(s): 1(114- <br /> /� <br /> Distance from Underground Storage Tank—T O LJ r Zeiss/-/-7 <br /> • . , vH ..CGt�c2 <br /> Distance from Hazardous Material Storage: <br /> Distance <br /> ft�om HHazardousus,W/a+�steStorage/:: <br /> EH 22 MS 4/90) <br /> `3- %� <br />