Laserfiche WebLink
`L <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT; SERVING <br /> Al Crow,Pros. 0) San Joaquin County <br /> Earl Pimentef,Vice Pres. 1601 East Hazelton Avenue ' City of Manteca <br /> Tommy Joyce,Secy. <br /> Stockton, California 95205 (/fit I I 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. San Joaquin County <br /> Daphne Shaw City of Stockton <br /> Harvey Williams,Ph.D. San Joaquin County <br /> APPLICATION FOR PERMIT TO CLOSE <br /> UNDER(M UN6 STORAcE TANKS MEIRG HAZARMUS MATERIALS 3d����� <br /> 1 � <br /> y� GENERAL INSTRUCTIONS: <br /> lJ Submit all information in triplicate. USE CARBONS. <br /> V. Include a detailed site map showing tank location and type, <br /> piping, streets and adjacent properties (north toward the <br /> top o the page) laca ion of nearby septic tanksr <br /> leachfields,page', <br /> dings and underground public utility lines <br /> (including water, sanitary sewer and storm sewer) . <br /> 3. Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br /> CLOSURE". <br /> 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 ilazardOUS waste generated on site, and <br /> specify the responsible party(ies) who will be disposing of <br /> tZ/ waste generated on site. <br /> 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. Compplete the San Joaquin Local Health District's (SJLHD) <br /> "Underground Tank Disposition Tracking Record". The holder <br /> of the permit shall. be respponsible for ensuring that this form <br /> � is completed and returned the SJLHD. <br /> 1b 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. vane ins ction notice of at least 98 hours is re uired b <br /> e an uin LocalAsa r>c Dpropria e a vane <br /> �>nsn e ion on ofjurisdictionalfireis�is <br /> contractor 's orsresponsibility. <br /> EH 23 040 <br /> REVISED 12/88 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468.3400 468-3030 468-3420 468-3860 <br /> Air Pollution Cc ity Services Laboratory • WIC <br /> 468-3470 W-3820 408-3460 468.3280 <br />