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BOARD OF TFIUSTEES SAN JOA©UiN LOCAL HEALTH DISTRICT <br /> James Culbertson, Pre, sERvtluca <br /> Patricia E Vannuccl Secy City of Loll <br /> Anthonette Van Sproneen 1801 East Hazelton Avenue, P O Box 2009 San Joaquin County <br /> i Earl Plmentai Stockton, Callfornla 95201 city of Estalon <br /> Fern Bugbep City of Manteca <br /> Daniel L Flores 20914$8-87$4 City of Repan <br /> John D Mast, M D City of Stockton <br /> WFlllam J Wade J091 Khanna. M o , M P H , plaint! Health Officer Clty of Tracy <br /> Mary Anna Love San Joaquin County <br /> San Joaquin County <br /> UNDERGROUND STORAGE TANK PROGRAM <br /> RE PERMANENT CLOSURE TANK REMOVAL POLICY* <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 workerq compensation insurance <br /> 4. Identify the tank(s) size and product(s) currently and/ar previously stored in <br /> each tank. <br /> 5. Provide the name of laboratory that will collect soil %amples 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 flarmi=,ble vapors to preclude <br /> explosion or to levels specified by existing rea,,, Iations <br /> 8. Method of disposal nr reuse <br /> a If the underground stordVc to ur- any part of an underground storage tank <br /> is destined for a soecific reuse. 1dent' fy tine 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 /> P c If the underground storage tank or any part of the underground storage tank <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 ith <br /> changes , or disapproved <br /> After approval of pian, contact with this office is required to schedule an inspec <br /> at least 24 hour's prior to tare\ removal/soil sampling ion <br /> � rile above general y � , <br /> 4 Policy shall apply to underground storage tanks white have no <br /> known unauthorized release or other unusual circumstances All other closures <br /> alay require additional site >pecific activities prior to approval of the closurr <br /> plan <br /> 3/8b Ut1 10 <br />