Laserfiche WebLink
gokmt :�'F'TRUSTEES SAN JOAOUIN LOCAL HEALTH DISTRICT SERVING <br /> M Craw,Pres. 5 San Joaquin County <br /> Carl pimentel,Vioa Pres., 1601 EASt Hazelton Avenin Cif of Manteca <br /> Tommy Jr+ycs.seat'. Stockton,Calliomla 95205 City of EwAton <br /> .fames F.Culbertson CNy of L" <br /> .john D.Mast,M.D. JOGI KNANNA, M.O., M.P.N.. DISTRICT NMTN OFFICER Cftlr of Tracy <br /> vlrglnl i Mathews City W Ripon <br /> Thomas Schube4 D.V.M. 3m dub'Cfwnly <br /> a <br /> HShaw Sm J aquin County <br /> Harveyrvey Williams,Ph.D. <br /> APPLICATTON FOR PFAMIT TO CLOSE <br /> 1. C13NERAL INSTRUCTIONS: <br /> 1. Submit all information in triplicate. USE CARBONS. <br /> (a'2. include a detailed site map showing tank location and type, <br /> ipingg, streets and adjacent properties (north toward the <br /> op of the pagge)) lotratIon of nearby septic. tanks <br /> leachfields, 6ui1dings and underground public utility lines <br /> (including water, aa►nifary Fewer and story newer). <br /> C� 3. Complete form form "J�LICATION 'FOR PERMIT FOR UNDERt,'ROUND TANK <br /> W4. [Complete the "Authorization to Release .Analytical Data" form. <br /> �Y5. submit the appppropriate fees and complete the "Underground <br /> Tank Program-Fee, Worksheet". <br /> O 6. procedures should explain decontamination technlgms 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 onsite. <br /> el. Procedures should explain purging and/or inerting Iaethod. <br /> CY B. Describe in detail how soil and/dr water samples beneath. the <br /> tank's invert will be obtained. Refer to "Sampling,Protocol <br /> for Routine Tank Removals" for sampling criterra. <br /> D"g. 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 /> IH'11. Advance InsDection notire of at lea§t IQ bourpa ed by <br /> th <br /> e 5a a ria van <br /> Insptict io iQLittgatioU o <br /> EH 23 040 <br /> REVISED 12/58 <br /> FE13 26 1991 <br /> ENVPI0 1T!SEVICESIAL LTH <br /> Administration Ctpniaal WAG" EnVNorwoft Health Public H•allh Mata n0 <br /> 466.3400 469.3630 Q&34" 4ss-3660 <br /> Air Pollution Cotr4mmlly swam Laborat" WIC <br /> 468-3470 466-3620 4bis-3460 468-3=0 <br /> Alma tnfrrMMtnn 4100 1Mn <br />