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9.4. Complete the "Authorization to Release Analytical Data" form. <br />5. Submit the appropriate fees and complete the "Underground <br />Tank Program Fee Worksheet". <br />[� 6. Procedures should explain decontamination techniques if <br />applicable, materials) utilized for rinsate, transportation <br />and/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 />C� 7. Procedures should explain purging and/or inerting method. <br />8. Describe in detail how soil and/or water samples beneath the <br />tank's invert will be obtained. Refer to "Sampling Protocol <br />for Routine Tank Removals" for sampling criteria. <br />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 Pian. <br />❑ 1.1. Advance insDection notice of at least 48 hours is required b <br />ewe rag tan Joaquin LocalHea is ric ro ria e advance <br />contor sor rspons1ibili�y�uris is lona ire districtis <br />EH 23 040 <br />REVISED 12/88 <br />Administration Clinical Services Environmental Health <br />468-3400 468-3830 468-3420 <br />Air Pollution Community Services Laboratory <br />468-3470 468-3820 468-3460 <br />AIDS Information 468-3820 <br />SERVING <br />San Joaquin County <br />City of Manteca <br />City of Escalon <br />City of Lodi <br />City of Tracy <br />City of Ripon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />PUBLIC HEALTH SERVICES <br />SAN JOAQUIN COUNTY <br />BOARD OF TRUSTEES <br />• • Al Crow, Pres. <br />P.O. Box 2009 <br />Earl Pimentel, Vice Pres. <br />(1601 East Hazelton Avenue) <br />Tommy Joyce,Sec'y. <br />Stockton, California 95201 <br />James F. Culbertson <br />John D. Mast, M.D. <br />JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER <br />Virginia Mathews <br />Thomas Schubert, D.V.M. <br />Daphne Shaw <br />Harvey Williams, Ph.D. <br />APPLICATION FOR PERMIT TO CLOSE <br />UNDERGROUND ?`E TANKS 9MRING HAZARMUS MATERIALS <br />I. <br />GENERAL INSTRUCTIONS: <br />(� 1. <br />Submit all information in triplicate. USE CARBONS. <br />(� 2. <br />Include a detailed site map showing tank location and type, <br />pipincl, streets and adjacent properties (north toward the <br />tanks, <br />ttop of the page) location of nearby septic <br />lines <br />leachfields, buildin:s and underground public utility <br />(including water, sanitary sewer and storm sewer). <br />l' 3. <br />Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br />CLOSURE". <br />9.4. Complete the "Authorization to Release Analytical Data" form. <br />5. Submit the appropriate fees and complete the "Underground <br />Tank Program Fee Worksheet". <br />[� 6. Procedures should explain decontamination techniques if <br />applicable, materials) utilized for rinsate, transportation <br />and/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 />C� 7. Procedures should explain purging and/or inerting method. <br />8. Describe in detail how soil and/or water samples beneath the <br />tank's invert will be obtained. Refer to "Sampling Protocol <br />for Routine Tank Removals" for sampling criteria. <br />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 Pian. <br />❑ 1.1. Advance insDection notice of at least 48 hours is required b <br />ewe rag tan Joaquin LocalHea is ric ro ria e advance <br />contor sor rspons1ibili�y�uris is lona ire districtis <br />EH 23 040 <br />REVISED 12/88 <br />Administration Clinical Services Environmental Health <br />468-3400 468-3830 468-3420 <br />Air Pollution Community Services Laboratory <br />468-3470 468-3820 468-3460 <br />AIDS Information 468-3820 <br />SERVING <br />San Joaquin County <br />City of Manteca <br />City of Escalon <br />City of Lodi <br />City of Tracy <br />City of Ripon <br />San Joaquin County <br />City of Stockton <br />San Joaquin County <br />Public Health Nursing <br />468-3860 <br />WIC <br />468-3280 <br />