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a0AR0 OF TRUSTEES SX.AQUIN LOCAL HEALTH DISTRICT SERVING <br /> James Culbortion, Praa. _11'' City of Lodl <br /> Patricia E. Vannuccl, Soc'y. V*83t <br /> San Joaquin County <br /> Anthonatta Van SPronaan Lof�\ Hazelton Avenue, P. O. Box 2009 City or Eacaion <br /> Earl Pimantal Q Stockton, California 115201 City of Manteca <br /> Fern eupbea `� 20g/468-6781 City of Ripon <br /> Daniel L. Florae City of Stockton <br /> John 0. Mot, M.D.A �Ma� 1-,,. Cfly of Tracy <br /> William J. Wade JoQI Khanna, M.D., M.P.H., District Health Of �oapuln County <br /> Mary Anna Low �}� ''lII�IJ`ee�''�r oaquln County <br /> Y7 UNDERGROUND STORAGE TANK PROGRAM JAN 2 0 087 <br /> RE : PERMANENT CLOSURE TANK REMOVAL POLICY' ENVIROMENTAL HEALTH <br /> PERMIT/SERVICES <br /> The following information shall be submitted in duplicate on all Permanent Closure/ <br /> Tank Removal Plans : <br /> I . Facility address and telephone number of owner (or operator if different than <br /> owner) . <br /> 2. Provide a parcel plot plan showing tank(s) to be removed and tank(s) distance <br /> from all premise septic tanks, buildings, and property lines, and all wells <br /> within 500 ft. <br /> 3. Provide the name of the contractor, including contractor' s classification, <br /> license number, and certificate of workers' compensation insurance. <br /> 4 . Identify the tank(s) size and product(s) currently and/or previously stored in <br /> each tank. <br /> 5. Provide the name of laboratory that will collect soil samples and a "Release of <br /> Information Authorization" form signed by the facility owner/operator. <br /> 6. Identify the method of disposal of all residual liquid, solids or sludges , <br /> if applicable. <br /> 7. Identify how the tanks will be purged of all flammable vapors to preclude <br /> explosion or to levels specified by existing regulations. <br /> 8. Method of disposal or reuse: <br /> a. If the underground storage tank or any part of an underground storage tank <br /> is destined for a specific reuse, identify the future underground storage <br /> tank owner/operator, location of use, and nature of use. <br /> b. If an underground storage tank or any part of an underground storage tank <br /> is destined for reuse as scrap material , identify this reuse to the <br /> San Joaquin Local Health District. <br /> c. If the underground storage tank or any part of the underground storage tank <br /> is to be disposed of, identify and document the method of disposal . <br /> On submission of the above information the closure plan will be approved, approved with <br /> changes ,. or disapproved. <br /> After approval of plan, contact with this office is required to schedule an inspection <br /> at least 24 hours prior to tank removal/soil sampling. <br /> a The above general policy shall apply to underground storage tanks which have no <br /> known ur(authorized release or other unusual circumstances. All other closures <br /> may require additional site specific activities prior to approval of the closure <br /> plan. <br /> 3/86 UGT 10 <br />