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BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT <br />James Culbertson, Pres. <br />Patricia E. vannuccl, Secy. <br />1601 East Hazelton Avenue, P. O. Box 2009 <br />Anthonette Van Spronsen <br />tt <br />Earl Pimentel <br />Stockton, Callfornla 95201 <br />Fern Bupbee <br />209/488 8781 <br />Daniel L. Flores <br />John D. Mast, M.D. <br />William J. Wade <br />Jopl Khanna, M.D., M.P.H., District Health Officer <br />Mary Anna Love <br />UNDERGROUND STORAGE TANK PROGRAM <br />RE: PERMANENT CLOSURE TANK REMOVAL POLICY* <br />SERVING <br />City of LodI <br />San Joaquin County <br />City of Escalon <br />City of Manteca <br />City of Ripon <br />City Of Stockton <br />City Of Tracy <br />San Joaquin County <br />San Joaquin County <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 workersr 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 taA <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 />* The above general policy shall apply to underground storage tanks which have no <br />known unauthorized 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 />