REMOVAL_1998 - Laserfiche WebLink

Home Browse Search

A_�—lggg P. 3 a 54AM FROM TAIT SACRAMENTO 916 635 2606 • PUBLIC HEALTH SERVICES SAN jOAQUIN COUNTY ENVIRONMENTAL HEALTH DIVISION Ernest M Fujimoto, M, D., M.P.H, Acting Health Officer ......_...p. O. Box 388 - Stockton, CA 95201-0388 cz 304 E. Weber Ave., Third Floor a P 2090468-3420 APPLtc�'1'toN FOR �� '"�cl. UNDERGBgl_STORAGE TANKS STORING HAZARDOUS MATERIAIG� I, GF,NERAL INSTRUCTIONS: Submit all information m triplicate- Answer all questions, leaving no blanks. One oopY will be retnmed to the applicant with comments. Include a detailed site map on a separate sheet of paper, showing the location of the tanks($), piping. .streets,adjacent properties(north toward the top of the page), nearby septic tanks, leaehfields,water weds, buildings,rmdergrouad public utility lines(including water, sanitary sewer and$term sewer), and distance of piping from tank to dispensers. If underground utilitie5ate oot included on the site map.You must state in writing that USA Dig will be contacted prior to excavation activities. L 7 3. Complete page 3, "Apptication for Underground Storage Tank Clasnre Permit". I] 4. Complete page 9, ".Autkoruatlun to Release'. This form must be signed and dated by the OWNEW01TRATOR of the facility. [ ) 5. Submit the appropriate fees and complete page 11, the 'Underground Storage Tank Program Fee Worksheet". I j 6- Completeall quesrians on page 10,the Public Health Services-Euviro tumemalrHealth Da tit nature and date D) those"Underground Storage Tank DispoAtion Trackimg ReMrtf% exceptqua-Mg g al. The holder of perres f the shall be responsible for ensuring that this form is weapieted of tank remov and returned to PHS-EHD within 30 days of be tank rettgval. ] 7. Suhmit a "Site Health & Safety Plan" as an addendum to this application, to address all potential hazards for this specific job site. Refer to the Site Safety plan Guidance Document for specifics- [] as equimd S. If facility is located outside of the City limits, submit "Uaa incorporated=3`* oCity Build ae Departments,by the County of San Joaquin Building Department pursuant to the Uniform Building Code STD 70-11. [) 9. Obtain a "Grading and Exeavatton Permit" from the City of Tracy Building Division prior to PIIS- EHD approval of the closure plan- () Of the adequately 10. The. maxirmtm review time far Closure Flans is LS working days from * with a 578 00 hmtrw completed.pl m. if gross deficiencies ate idetrified,an addenthtm will be required fee and the review will begin on the dart of reudbm ttal_ L 1 11. Subnvt verificacton of the fire permit from the 2pprapt5a1e fire district at the removal inspection. [) 12 Advance nistiection notice of at least 48 hours is rewired by PHS-EHD. EH 23 W (Revised 9111196) Page I A Ditiision of San lnaguin Comw Health Cara Srn',ces