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PUBLIC-HEALTH SERVICES U1M . <br /> �cA� <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DIVISION <br /> Ernest M. Fujimoto, M.D., M.P.H., Acting Health Officer <br /> 445 N. San Joaquin Street • P.O. Box 388 • Stockton, CA 95201-0388 <br /> (209) 468-3420 <br /> CLOSURE IN PIACE <br /> Business/OwneesName: Production Chemical Manufacturing, Inc . Lewyn Boler <br /> Facility Address: 100d East Channel Street Stockton , CA 95205 <br /> Tanks) Number. 1044-01 Sweeps Number. Computer Number. <br /> Applicant's Name: Production Chemical' . Phone'No: 943-7337 Date Submitted: June 3, 1994 <br /> [ ] 1. Loral County/City Fire District shall approve the Closure in Place (CEP) prior to Environmental Health <br /> Division (PHS/EHD) approval. <br /> ( ] 2. A registered geologist or qualified consultant shall submit the CIP proposal. <br /> [ ] 3. The applicant shall complete the"Application-Environmental Health Permit/Services'form and remit a 5159 <br /> workplan review fee. Any additional review time required will be assessed atavrur. <br /> Ar • <br /> [ ] 4. The applicant shall submit a technical workplan which includes the details of the proposed construction: <br /> a) The reason for requesting a closure-in-place. <br /> b) History of the tank site: Previously and currently stored contents, tank capacity, tank location, any <br /> obstacle dictating boring locations,and any failed precision tests or unauthorized releases associated <br /> with the tank. <br /> c) Cross-sectional drawing of tank and proposed angle borings. (Indicate where the borings will <br /> terminate) <br /> d) A minimum of two borings and four soil samples per tank. (Indicate where samples will be collected) <br /> e) A description of sampling protocol and types of analyses to be performed. (If water is encountered, <br /> a water sample shall also be collected) <br /> f) Provide this office with the minimum detection limits that will be utilized in the suggested analysis. <br /> g) Obtain an EPA identification number for hazardous waste that is generated on site. <br /> h) Provide a hazardous waste manifest for any hazardous waste that is generated on site. <br /> i) Provide method for sealing the boring(s) and indicate sealing material to be utilized. <br /> [ ] 5. The applicant shall complete the "Application for Permit SJLHD" and remit S89 boring permit fee. <br /> a) An initial fee 9f S89 includes the fust hour of inspection time. If additional inspection time is <br /> required, a; per hour fee will be assessed 7$— <br /> b) The above application shall be signed by the licensed drilling contractor or his authorized agent. <br /> (This authorization shall be submitted in writing.) <br /> c) A separate and complete "Application for permit S.TLHD" form and S89 permit fee is required for <br /> each separate parcel. <br /> d) The drilling contractor performing work must have on file: <br /> 0 A copy of the C-57 well driller's license. <br /> o A current copy of Worker's Compensation Insurance certificate. <br /> o A completed "Contractor's Questionnaire". <br /> [ ] 6. The applicant shall complete the "Authorization to Release Analytical Information" form and obtain the <br /> signature of the property owner or his authorized representative. <br /> [ ] 7. A notice to be placed on the deed of the property (describe exact vertical and areal location of the closed <br /> UST, the hazardous substances it contained, and the closure method). <br /> [ ] 8. Approved by REHS: Date: <br /> EH 23 039 (Rev 3/11/91) <br /> 0 <br /> A Di.ixion of San Juayuin CnnInk.ftealth Care Svr%iee< <br />