Laserfiche WebLink
Ffa zo or <br /> BOARD -JF TRUSTEES Sk,-JOAQUIN LOCAL HEALTH DIS _.CT SERVING <br /> At Crow,Pree. San Joaquin County <br /> Earl Plmentel,Vice Pres. 1601 East Hazelton Avenue City of Manteca . <br /> Tommy Joyce,Secy. Stockton, California 95205 City of Escalon <br /> James F.Culbertson City of Lodi <br /> John D.Mast,M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews City of Ripon <br /> Thomas Schubert.D.V.M. SOD :�^fkr Srt San Joaquin County <br /> Daphne Shaw City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> APPLICATIONR PERMIT TO CLOSE <br /> UNDERGROUNIS�TyRACF FOMIRING S MATERIALS <br /> GENERAL INSTRUCTIONS: <br /> Submit all information in triplicate. USE CARBONS. <br /> f <br /> luaddee a detailed site map showing tank location and type, <br /> incstreets and adjacent properties (north toward thethe page) location of nearby septic tanks, <br /> chfieIds, buildings and underground public utility lines <br /> (including water, sani6ry sewer and storm sewer) . <br /> V,y 3. Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br /> CLOSURE". <br /> �9. Complete the "Authorization to Release Analytical Data" form. <br /> �i r"' ®5. Submit the appropriate fees and complete the "Underground <br /> Tank Program Fee Worksheet". <br /> 6. Procedures should explain decontamination techniques if <br /> applicable, material(s) utilized for rinsate, transportation <br /> at storage of hazardous waste generated on site, and <br /> specify the responsible party(ies) who will be disposing of <br /> waste generated on site. <br /> �7. Procedures should explain purging and/or inerting method. <br /> �l 8. Describe in detail how soil aril/or water samples beneath the <br /> Z v tank's invert will be otltained. Refer to "Sampling Protocol <br /> e�2 for Routine Tank RemovAl.s" for sampling criteria. <br /> C)9. Complete the San Joaquin Local Health District's (SJLHD) <br /> "Underground Tank Disposition Tracking Record". The holder <br /> of the permit shall be responsible for ensuring that this form <br /> is completed and returned the SJLHD. <br /> ❑ 10. The maximum review time for Closure Plans is 15 working days <br /> from the date of receipt of the adequately completed Plan. <br /> ❑ 11. Advance i ection notice of at least 48 hours is re wired b <br /> L e an t>a win .ocasAea District. a vance <br /> inn�no i ica ion of jurisdictionalire district is <br /> cosrctior 's <br /> responsibility. <br /> EH 23 040 <br /> REVISED 12/88 <br /> Administration Clinical Services Envi.onmental Health Public Health Nursing <br /> 468.3400 468-3030 468-3420 468-3960 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 463-3820 4G8-3460 468-3280 <br /> AIDS Information 468-311M <br />