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0 4P <br />Public Health Services of San Joaquin County <br />Environmental Health Division <br />BUS24M LICENSE SURVEY <br />I. Does the business handle Itwwdous, Material? -7 Yes �-r' No <br />5'v 1.,-e A,/5- Of <br />2 <br />FA <br />b. <br />Amount:— <br />Does the business generate Iwage? <br />Yes No <br />r -5� <br />IL <br />Tyw- <br />b. <br />Amount generated per month:. 1-5-a <br />C. <br />EPA 7 L.) <br />d. <br />Storage method and time stored on premise- -70 <br />0. <br />Waste disposal method: <br />3. Is the business presently under any Permits? <br />Yes No <br />A. <br />State Permit A <br />b. <br />CRWQCIl Discharge Requirement <br />C. <br />County Permit <br />d. <br />Other. <br />4. Type of sewage disposal system <br />9. <br />Private Septic system <br />PHS/EHD Sanitation Permit #: <br />b. <br />Public <br />� <br />System: <br />City Discharge Permit #: <br />5. Type of Water Supply <br />a. of Putic 1120 <br />I Jj, h <br />PZIHIFD Well Permit #: <br />Number of Employees: <br />Distance from septic system(s): <br />Distsined from septic system(s): <br />Distance from !Underground Storage Tant <br />Distance front Hazatdous Material Storage: <br />Distance from Hazardous Waste Storage: <br />