Laserfiche WebLink
San Joaquin County <br /> fT � . Environmental Health Department <br /> DIRECTOR <br /> Liinda Turkkatte , REHS <br /> a 41 <br /> 1868 E . Hazelton Avenue <br /> Stockton , California 95205 =6232 PROGRAM COORDINATORS <br /> Robert McClellon , REHS <br /> Jeff Carruesco , REHS , RDI <br /> r f:) Y; i Website : www . sjgov . org /ehd Kasey Foley , REHS <br /> Rodney Estrada , REHS <br /> Phone : ( 209 ) 466 -3420 Willy Ng , REHS <br /> Fax : ( 209 ) 464=3433 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> [ ] 1 . Submit all information in triplicate . Answer all questions , leaving no blanks . One copy will be returned to the <br /> applicant with comments . <br /> [ ] 2 . Include a detailed site map on a separate sheet of paper showing all work to be done . Include the location of <br /> the tanks (s) , piping , all tank-related appurtenances , streets , adjacent properties (north toward the top of the page) , <br /> nearby septic tanks , leachfields , water wells , buildings , underground public utility lines ( including water, sanitary <br /> sewer and storm sewer) , and distance of piping from tank to dispensers . If underground utilities are not included <br /> on the site map , you must state in writing that USA Dig will be contacted prior to excavation activities . <br /> [ ] 3 . Complete pages 3-6 , "APPLICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR PIPING <br /> REPAIR PERMIT" . NOTE : If sampling is required , sampling firm shall be an independent third party from the <br /> contractor performing the work . <br /> [ ] 4 . Complete page 7 , "Authorization to Release" . This form must be signed and dated by the <br /> OWNER/OPERATOR of the facility . <br /> [ ] 5 . Submit a completed " Service Request" form and " Underground Storage Tank Program Fee Worksheet" . <br /> [ ] 6 . If performing any excavation activities , and the facility is located outside of the city limits , submit a " Backfill <br /> Excavation Certificate" as required by the San Joaquin County Building Department. If a " Backfill Excavation <br /> Certificate" is required by any incorporated areas (cities) , submit to the appropriate City Building Departments , <br /> pursuant to the Uniform Building Code STD 70- 11 . <br /> [ ] 7 . The maximum review time for Plan Review is 15 working days from receipt of the adequately completed plan . If <br /> gross deficiencies are identified , an addendum will be required with a $ 139 . 00 per hour fee and the review will <br /> begin on the date of resubmittal . <br /> ( ] 8 . Advance inspection notice of at least 48 hours is required by the Environmental Health <br /> Department ( EHD ) . <br /> [ ] 9 . Contractor to Provide : Combustible/Flammable gas detector (to verify the Lower Explosive Limit ( LEL) <br /> atmosphere and oxygen level ) , adequate number(s) and appropriate type (s) of fire extinguisher(s) , and barriers to <br /> secure the area as necessary to minimize traffic and pedestrian interference . It shall be the project manager' s <br /> responsibility for compliance with all health & safety regulations and requirements , including confined space <br /> requirements , which shall be strictly adhered to at all times during the course of the underground storage tank <br /> (UST) activities . <br /> [ ] 10 . The EHD permit shall be on site during all UST permit- related activities . <br /> [ ] 11 . Any changes in this document shall be approved by the EHD prior to initiating work . All changes to any work <br /> must be described in detail on pages 3 & 4 and be shown on the detailed site map . <br /> EH230038 (revised 7-26-2016) 1 <br />