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APR -01-03 05:51 PM <br />Is <br />FIFTHFLOM <br />Is <br />., <br />P.03 <br />ENVIRONMENTALDEPARTMENT <br />SAN JOAQUIN COUNTY <br />f1mosup"i"'s <br />/ r4 <br />t ' �. <br />. , , , <br />r Californiaa �f <br />Al.rMike <br />r • ! °' Q <br />Pmvram Manager <br />Fax: 09 464-0138 <br />a, <br />Applicant'sBusintWOwner's Nam: <br />Facility Ad4m: <br />{ s _ Date Subtinined; <br />DistrictLocal County/Ciry Fite <br />t + 3 <br />(jappioval- <br />2. A real red geologist or qualified consultant iihall sub °t the Cip proposil <br />(I 3. The applicant shall corriplele dw *Application perprut to Close VvdtrpvWW storage T s Sionag <br />Hazardous erials" forst and remit a 5267 review fee, Any additional review ran@ required will be assessed <br />at 3119 per how <br />(j 4- The applicant shall subatit a t cal work g! which includes the details ofthe proposed a cdon; <br />a) The reason for requesting a clostge-iplace. <br />b) History of the mk site: Previously and currently stored contents, tank capacity. tank loation, any <br />obstacle dictating locations, and any failed precision tests or au d release$ associated <br />with the tank <br />C) Crose-stctimal drawing of tank and proposed angle borings. (Indicate where the Wrings wil) <br />tc te) <br />d) A itninfinum of two borings ad abut soll sarMles per tank. (Indicate wbare sanviss will be collected) <br />0 A descrfption of sampling protocol s of analyses to be pert ed. (If water is encountercd. a <br />waWr s ta 91tall also be collet <br />f} Provide this ofilce with the ininirowndetection lings that v4ll be tanlized in the suggested analyits. <br />Obtain an EPA Identification number for hmrdm waste that is gcacra W. <br />h) v a hatardoits waste isiandlist for any haurdous watt thatis generated on site. <br />i) Provide nwftd for sealing the boring(s) and indicate sealing rrrial m be utilized. <br />an $89 per hour he will be assesset <br />b) Die above application "I he signed by dw licensed drilling conWacigr or his authoria;ed agent. (This <br />audiontation shall be subtriined in writing.) <br />C) A separate and complete "Apphattion 1br perrr&it MEW fonn ind $89 pora* tee, is required for <br />.: Ttw drilling . r r rr pofornift work must beve *a <br />the <br />i <br />shall6. Ike applicant a r <br />Asonee to beplaced on the deed of .: . (4esciribe exact vertical aFW1 wnal localonoftlie closed <br />the hazardous substances is contsinc4i and te E` R). <br />i. <br />