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W 4 9 <br />4&CGRS <br />SOLUTIONS DELIVERED <br />zo�9 <br />Et !i\119Oi ,I"ENTAL <br />Nr_All TW. f)C10a.QPflFN'T <br />GENERAL CONTRACTOR STATEMENT <br />Effective OS/26/15, the State Water Resources Control Board now requires a signed statement from all <br />general contractors prior to final ELD testing. <br />By signing below, the general contractor acknowledges that: <br />"No further ground penetrating work, including beautification requirements, atop or immediately <br />adjacent to, the UST system are needed or will be performed after ELD testing is performed." <br />General Contractor Information <br />Company Name/CA License r: Walton Engineering <br />Contact: Michael Walton <br />Address: PO Box 1025, West Sacramento, CA 95691 <br />Telephone/Email: 916-372-1888/m.walton@waltonengineering.com <br />Site Information <br />Site Name: <br />Chevron <br />Address: <br />1490 S. Main St., Manteca, CA 95337 <br />Telephone: <br />unknown <br />County: <br />San Joaquin <br />CUPA Contact: <br />San Joaquin County Environmental Health <br />CUPA Phone/Ernail: <br />ust@sjcehd.com <br />Testing Company Information <br />Name: CGRS, Inc. <br />Technician Assigned/License It: Sergio L. Nunez/006-1727 <br />Signature <br />General Contractor's Signature: <br />Name (print): C 12U" -J J C <br />�7 <br />Title: 1�, /�- <br />< <br />?r % ?/t-/ <br />Date of Signature: % <br />5444 Dry Creek Rd. Socromento, CA 95838 T 916-991.1100 f 916.991.1177 www.cgrs.com <br />