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BOARD OF TRUSTEES <br />AI Crow, Pree. <br />Earl Plmentel, Vice Pres. <br />Tommy Joyce. Sec'y. <br />James F. Culbertson <br />John D. Mast M.D. <br />Virginia Mathews <br />Thomas Schubert D.V.M. <br />Daphne Show <br />Harvey Williams, Ph.D. <br />SAN oVA0UIN LOCAL HEALTH DISTRICT SERVING <br />gg <br />• It• r• • 1 �livL V:1CIYo1f.HICe.;�hLy:f: •1• � •'1 Ir• <br />�/I. GENERAL INSTRUCTIONS: <br />L( 1. Submit all information in triplicate. USE CARBONS. <br />[� 2. Include a detailed site map showing tank location and type, <br />piping, streets and adacent properties (north toward the <br />top of the paga) location of nearby septic tanks, <br />leachfields, buiidings and underground public utility lines <br />/ (including water, sanitary sewer and storm sewer). <br />Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br />�I�4. 33let <br />Complete the "Authorization to Release Analytical Data" form. <br />l"J 5. Submit the appropriate fees and complete the "Underground - <br />Tank Program Fee Worksheet". <br />C� 6. Procedures should explain decontamination techniques if <br />applicable, material(s) utilized for rinsate, transportation <br />atx7 <br />/or 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 />i L�4. Describe In detail how soil and/or water samples beneath the <br />tank's invert will be obtained. Refer to "Sampling Protocol <br />ET-19. <br />�for Routine Tank Removals" for sampling criteria. <br />I i 9. Compplete the San Joaquin Local Health District's (SJLHD) <br />EnthegppeermitRshallibeorespponsiblekfor ensuriing that holder <br />is completed and returned the SJLHD. <br />EJ 10. The maximum review time for Closure Plans is 15 working days <br />from the date of receipt of the adequately completed Plan. <br />Il 11. Advance inspection nntirp of tet- 11. " 4D ti....__ t_ <br />EH 23 040 <br />REVISED 12/88 <br />Administration <br />468.3400 <br />Clinical Services Environmental Health <br />460-3030 460-3420 <br />Public Health Nursing <br />468-3960 <br />Air Pollution Community Services Laboratory WC <br />468.3470 460-3820 408-3460 468-3280 <br />AIDS Inlormation 468-307.1 <br />San Joaquin County <br />1601 East Hazelton Avenue <br />Cfty of Manteca <br />Stockton, California 95205 <br />City of Escaton <br />Cly of Lodi <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />City of Tracy <br />City of nipon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />gg <br />• It• r• • 1 �livL V:1CIYo1f.HICe.;�hLy:f: •1• � •'1 Ir• <br />�/I. GENERAL INSTRUCTIONS: <br />L( 1. Submit all information in triplicate. USE CARBONS. <br />[� 2. Include a detailed site map showing tank location and type, <br />piping, streets and adacent properties (north toward the <br />top of the paga) location of nearby septic tanks, <br />leachfields, buiidings and underground public utility lines <br />/ (including water, sanitary sewer and storm sewer). <br />Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br />�I�4. 33let <br />Complete the "Authorization to Release Analytical Data" form. <br />l"J 5. Submit the appropriate fees and complete the "Underground - <br />Tank Program Fee Worksheet". <br />C� 6. Procedures should explain decontamination techniques if <br />applicable, material(s) utilized for rinsate, transportation <br />atx7 <br />/or 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 />i L�4. Describe In detail how soil and/or water samples beneath the <br />tank's invert will be obtained. Refer to "Sampling Protocol <br />ET-19. <br />�for Routine Tank Removals" for sampling criteria. <br />I i 9. Compplete the San Joaquin Local Health District's (SJLHD) <br />EnthegppeermitRshallibeorespponsiblekfor ensuriing that holder <br />is completed and returned the SJLHD. <br />EJ 10. The maximum review time for Closure Plans is 15 working days <br />from the date of receipt of the adequately completed Plan. <br />Il 11. Advance inspection nntirp of tet- 11. " 4D ti....__ t_ <br />EH 23 040 <br />REVISED 12/88 <br />Administration <br />468.3400 <br />Clinical Services Environmental Health <br />460-3030 460-3420 <br />Public Health Nursing <br />468-3960 <br />Air Pollution Community Services Laboratory WC <br />468.3470 460-3820 408-3460 468-3280 <br />AIDS Inlormation 468-307.1 <br />