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PUI3LIC HEAEM SEIrACES ��tl a <br /> )• !;k <br /> r• a 1 <br /> SAN JOAQUIN MUNTY <br /> J(Kil KIIANNA M.U.,M.I'.11. <br /> I Icaldn 011i(cr <br /> � ticdp�� <br /> P.O. Do: 2(Ny) (ICAII Gas( I lazeltran Avenue) • SI(aknm,California(15201 <br /> 12119) 468-3400 <br /> APPIACATION FOR 1 ERN1111 1O CLOSE. <br /> UNIIIsltl;ItUUND S'1'OI(Al�l:'TANKS S'I'UItING IIA'LAItIIUUS MA'1GIt1AIS <br /> GENERAL INS'I'RUCI1ONS: <br /> 1. Submit all infonualion in triplicate. One copy is returned to tine applicant with coeomeets. <br /> u 2. Include r detailed site wap, un a separate shcel of paper, showing lank location and type, piping, ' <br /> h toward the lop of the page),location of the nearby septic tanks, <br /> selects and adjacent pruperties(not[ <br /> Icachliclds,wells,buildings,underground public utility lines(including water,sanitary sewer and so)[un <br /> sewer), and distance u[ piping [runt lank to dispensers. <br /> ,l. Complete page 7, "Applicalion for Underground Tank Closure ['erode". <br /> V �4 Crurplelc page 9, "Autborizalloa in Release Analytical Dnlll. <br /> ( S. Sabath the alglFOI rialC fees mrd complete page 11,the"Undergrouad'I'mtk program Fee Worksheet'. <br /> Yr (i. Describe oil pages 4 rrr 5 the decontannbaatioll lechniques if applicable,maletial(s)utilized for riusale, <br /> transportation and/or swrage ti[ harndous waste generated oe site, and specify the responsible <br /> Ila,ly(ies) who will be disposing of waste gencnated on site. <br /> j 7• Describe uo page 5 the onelhod for purging and/or beetling mnk(s) and piping. <br /> J r <br /> H. Desclibe on page 5 ie dcmil how still and/or wader sauplcs beneath the lauk(s) and piping will be <br /> obtained. <br /> 9• Complete the pertioad section of page 10,the Public liealib Services-Environmental l health Division <br /> (ITIS-II IU) "lludergrouud 'lytuk Ulsposfllou '1'rucklag Recut". 'I'hc holder of Ilne penult shall be <br /> responsible for ensuring that this (ono is completed and returned to PIIS-EI ID. <br /> III. <br /> Submit a "She Ilcullh & Safety I' RImi, as an addendum to this application, to address all potential <br /> Submit for this specilic Jab sire. efer W Site Safety Plat Guidance Document for specifics. <br /> 11. Submit at "Compaction Report" Ins required by the County of San Joaquin Duilding Department and <br /> .it's Incorporated City Building DeParintculs, pursuant to the Uniform Building Code STD 70-1. <br /> LQ, 12. obtain a "Grading and Kxcrvntion 1'erndl" bum the City of'['tarty Building Division prior lu PIIS- <br /> rill) approval of the closure Plan. <br /> j J LL tiietcelpt of l <br /> e adequately <br /> coopleledplan. it glom deficieeeiesarc identified,an addendum willbe requiredWith a $53.(lf) mur <br /> (cc and the review will begin oil the dale of recubmi0al. <br /> j 14. Submit verilicatiun of the fire perm, from the appropriate fire district (prior to scheduling removal <br /> Inspecllon). <br /> IS. Advance Inspecliuo notice Of rel least 48 hours is lquiicd by Public I Icalth Services. <br /> Page 1 <br /> A INO,inn M San J11"11"Courcy I loldi(.ar<So•ias <br />