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a <br /> t <br /> Y <br /> R' <br /> SERVING <br /> OWN LOCAL HEALTH DISTRICT City of Lodi <br /> sOARt)Of YRUSYt ES S San Joaquin Counly <br /> J- •s culbarlson.Prot. 1 BOX 2QQg city Of Escalon <br /> E.Yannuccl,Sec'Y. city <br /> Hazeiton Avenue,P.0. city of of RI on <br /> Anthonalla Yen SDlOnasn G� �1 Stockton,f;alftenia 95201 Cllyol Ripon <br /> Eart Pimontal �{}gl4gg-8781 Cllyol Slockton <br /> Fern avgbaa 1 � City Of ytscy <br /> Daniel L. Ftotasoaquln County <br /> John 0. Mast. M.O. Jopi Khanna.M.o.. M.P.H.,District H"'Ih of In County <br /> Wllllam J.Wada <br /> Mary Anna Low JAN 'L,187N 2 V 'L,187Y UNDERGROUND STORAGE TANK PROGRAM .1H <br /> 1tE: PERMANENT Ci.OSURE'TANK REMOVAL POLICY` <br /> C�FIk-R,ROMIT/5 f1V C SLTH <br /> The <br /> following information shall be submitted in duplicate on all Permanent Closure/ <br /> Tank Removal Plans: . - <br /> 1, Facility address and telephone number of owner (or operator if different once <br /> owner), to be removed and tank(s) dist <br /> 2. Provide a parcel plot plan showing tank(s) <br /> from all premise septic tanks, buildings. and property lines. and all wells <br /> within 500 ft. <br /> 3. Provide the name of the <br /> certificatetof, including workers' compensationrinsurance�ication, <br /> license number, currently and/or previously :;,,red in <br /> 4. Identify the tanks} size and products) <br /> each tank. il <br /> 5. Provide the name Oflaboratory <br /> abiorat ry thatwill <br /> collecthe acilitysowner/operato`rRe}ease o <br /> t so <br /> Identifyith Author <br /> (;, Identify the method of disposal of all residual ]iquid. Solids or sludges, <br /> 7, <br /> if <br /> applicable.fy how tanks will be purged of all flammable vapors to preclude <br /> explosion or to levels specified by existing <br /> regulations. <br /> g. Method of disposal or reuSe': art of an underground storage tank <br /> a. If the underground storage tank or any p <br /> is destined for a specific reuse, identify the f3ture underground storage <br /> tank 0%%mer/operator, location of use, and nature of use,of an underground storage tank <br /> b. if an ul,_ rground storage tank or any p <br /> is destined for reuse as scrapim�terial , identify this reuse to the <br /> San Joaquin Local Health art of the, underground storage tank <br /> C. If the Ind rground storage tank or any R <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 with <br /> changes,. 6r disapproved. <br /> After approval of plan, contact with <br /> iiremoval/soil thi fice is <br /> snrequired to schedule an inspection <br /> at least 24 hours prior to tank <br /> ----- _ <br /> und storage <br /> licy <br /> to un <br /> The abovegeneral All other cclosures <br /> known udauthor theractivities prior to approval of the closure <br /> may require additional site specific <br /> plan, <br /> 3/86 UGT 10 <br />