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S A N ,,J O A Q U I N Emmental Health Department <br />COUNTY <br />5. Inert UST with 30 pounds of dry ice per 1,000 gallon volume after triple rinsing. Be <br />aware, additional testing/monitoring to ensure tanks remain inerted may be required by <br />the Stockton Fire Department. <br />6. A copy of the submitted "Health and Safety Plan" must be on the jobsite for review. <br />7. See `Sampling Protocol for Routine Tank Removals' and `Verification Analysis' on page <br />6 and 7 of the permit application for required analytical tests and number of samples to <br />be taken and witnessed by EHD. <br />8. A copy of the Fire Department permit must be submitted at the time of removal. <br />9. In addition, the following information must be submitted within 30 days after the UST <br />removal date: <br />a. Analytical results: only results that come directly from a third party California <br />certified laboratory with affixed chain of custody will be accepted by EHD <br />b. UST Tracking Record Sheet and/or Tank and Piping Hazardous Waste Manifest <br />c. Tank Closure Certification Form (DTSC Form 1249) <br />d. Hazardous Waste Manifest for rinsate and residual product <br />e. Backfill Excavation Certificate <br />10. Permit expires 180 days from the date of approval. If an extension to the expiration <br />date is required, a written request must be submitted to this office prior to the expiration <br />date. <br />If you have any further questions, please contact me at (209) 468-3440. <br />Thank you, <br />Stacy Riv , REHS <br />Senior Registered Environmental Health Specialist <br />Cc: Sweet Howard N TR, 7424 Spy Glass Dr., Modesto, CA 95356 <br />7 -Eleven, 2711 N. Haskell Ave., Dallas, TX 75204 <br />2 of 2 <br />