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REMOVAL_2010
EnvironmentalHealth
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2300 - Underground Storage Tank Program
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PR0535591
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REMOVAL_2010
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Last modified
11/4/2020 2:39:03 PM
Creation date
11/4/2018 4:03:42 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2010
RECORD_ID
PR0535591
PE
2361
FACILITY_ID
FA0020519
FACILITY_NAME
MCBILLIN REAL ESTATE INVESTMENT
STREET_NUMBER
2154
Direction
S
STREET_NAME
EL DORADO
City
STOCKTON
Zip
95203
APN
16705021
CURRENT_STATUS
02
SITE_LOCATION
2154 S EL DORADO
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
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SJGOV\rtan
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FilePath
\MIGRATIONS\E\EL DORADO\2154\PR0535591\REMOVAL 2010.PDF
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EHD - Public
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ENVIRONMENTAL HEALTH DEPARTMENT <br /> aRRgl" SAN JOAQUIN COUNTY <br /> r` Unit Pro am Coordinators <br /> '4 Donna K.Horan, R.E.H.S. 8r <br /> Director 600 East Main Street Carl Borgman,R.E.H.S. <br /> Stockton, California 95202 Mike Huggins,R.E.H.S., R.D.I. <br /> • Y.� Margaret Lagorio, R.E.H.S. <br /> {�ia6Ri; Laurie A. Cotulla,R.E.H.S. Telephone: (209)468-3420 Robert McClellon, R.E.H.S. <br /> Assistant Director Fax: (209)468-3433 Jeff Carruesco,R.E.H.S. <br /> Kasey Foley, R.E.H.S. <br /> APPLICATION FOR PERMIT TO CLOSE <br /> UNDERGROUND STORAGE TANKS STORING HAZARDOUS MATERIALS <br /> I. GENERAL INSTRUCTIONS: <br /> [] 1. Submit all information in triplicate. Answer all questions, leaving no blanks. One copy will be returned to the <br /> applicant with comments. <br /> [] 2. Include a detailed site map on a separate sheet of paper, showing the location of the tanks(s), piping, streets, <br /> adjacent properties(north toward the top of the page),nearby septic tanks, leachfields,water wells,buildings,underground <br /> public utility lines (including water, sanitary sewer and storm sewer), and distance of piping from tank to dispensers. If <br /> underground utilities are not included on the site map, you must state in writing that USA Dig will be contacted prior to <br /> excavation activities. <br /> [] 3. Complete pages 3-6, "Application for Underground Storage Tank Closure Permit". 54ct : Sampling firm shall <br /> be an independent third party from the contractor. <br /> [] 4. Complete page 9, "Authorization to Release". This form must be signed and dated by the <br /> OWNER/OPERATOR of the facility. <br /> [] 5. Submit a"Service Request' form with the appropriate fees, submit completed UPC forms for Facility and Tanks <br /> (formerly State A&B forms)and complete the"Underground Storage Tank Program Fee Worksheet'. <br /> [] 6. Complete all questions on page 10, the Environmental Health Department (EHD) "Underground Storage Tank <br /> Disposition Tracking Record",except those requiring a signature and date of tank removal The holder of the permit shall <br /> be responsible for ensuring that this form is completed and returned to EHD within 30 days of the tank removal. <br /> [] 7. Submit a"Site Health& Safety Plan" as an addendum to this application,to address all potential hazards for this <br /> specific job site. Refer to the Site Safety Plan Guidance Document for specifics. <br /> [] 8. If facility is located outside of the city limits, submit a 'Backfill Excavation Certificate" as required by the <br /> County of San Joaquin Building Department and the incorporated City Building Departments, pursuant to the Uniform <br /> Building Code STD 70-11. <br /> (] 9. Obtain a "Grading and Excavation Permit" from the City of Tracy Building Division prior to EHD approval of <br /> the closure plan. <br /> [] 10. The maximum review time for Closure Plans is 15 working days from receipt of the adequately completed plan. If <br /> gross deficiencies are identified, an addendum will be required with a $105.00/hour fee and the review will begin on the <br /> date of resubmittal. <br /> [] 11. Submit verification of the fire permit from the appropriate fire district at the removal inspection. <br /> [] 12. Advance inspection notice of at least 48 hours is required by EHD <br /> [] 13. Submit Contingency Plan for over-excavation at time of UST removal(if planning to over-excavate). <br /> See"III. SITE MITIGATION"on Page 2. <br /> EH 23 046 (Revised 07/31/08) 1 <br />
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