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9 <br /> ''•t � Ban Joaquin SI:fISINQ <br /> " SAN JOA�IUIN LOCALHEAI.TF! ® TE�ECT <br /> BOARD air TFlUBTIdE� County <br /> A crew.Pres. 1604 Enst Hazellon AYenUtS city el Manteca <br /> earl ptmranlaf,Vice Pres CEty or Eacaton <br /> Tommy doyco,Beo'Y• Slocklan,C811iornla 95205 CIV o1 Lodi <br /> P.Wbertoon city of Tracy <br /> Janjes <br /> .Sohn D.fvlaol M.D. JOQI KHAHNR, 0.1.x., 141.9.H., �"7pICT ',FJIiTfI OFFICER Citi of Ippon <br /> Virginia MelhGws�` Ban Joaquin r;Dunty <br /> ThomSon Joaquin County <br /> Stockton <br /> Daphne Show \• <br /> Harvey rA IIISms,Ph.D. <br /> pLICATI(Ha >!!tM T To CLOSE <br /> nw—PrILMCI RUN <br /> MVERAL INSTRUCTIONSt <br /> [' <br /> submit all inEormation in trip].!cats. U86 s• <br /> I vs 11"' -n ce rf�1 <br /> ter . Incluse a detailed : e map show{ng tank location and t , <br /> iptngy, streets and ail acent properties north toward the <br /> topo£ the page loca ion of nearby Sep is tanks <br /> leachflelds, u ldinys alxl underground public utflity lines <br /> � (including water, sanitary sever and storm sever). <br /> . Gamplete form "APPLICATION FOR PERMIT FM UNDERGROUND TAM( <br /> CLUSL�". <br /> Complete the "Author to Release Analytical Data" form• <br /> Submit thap eepRorkehfees,and complete the "Undergrtiund <br /> Tank Program <br /> 5. Procedures should exxpplain deconcamination techniques is <br /> ap licable, matetlal(s) utilize for rinsate, tran9por anon <br /> att /or storage of hazardous waste genera ed on site, and <br /> tspecifyte the teiponsible.party(ies! who w 11 be disposing of <br /> Procedures should explain purging and/ax inerting method. <br /> ! ly g• Describe In detail It�aaroetained and/or tos"Sameling Protocol <br /> tanks Invert will <br /> for Routine Tank Removals" for. sampling crater a. <br /> �9. Complete the San Joaquin Local I{ealth D ecorlt'a the f older <br /> "Underground Tank Disposition TTrajr for ensurd". <br /> of the permit shall. be responsible for ensuring that this form <br /> is completed aivi returned L•he SJLHD. 44 gg ' <br /> E�1 / froom themdateeof recelptfOf thesadequatelyicompletedlPiada. <br /> 11. ys <br /> a on i <br /> ae v <br /> s a c on <br /> a S <br /> EH 23 040 <br /> RWISFD 12/88 <br /> Admlrslotredon Clinical Services__ finvlronrnental Health Public Health Nursing <br /> 1166-903D 4811-3420 469.3860 <br /> 488.3400 <br /> Air Ppltutian Community Services <br /> Laboralory C <br /> .409.3410 <br /> 460.57217 469-3480 .4011.9290 <br />