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"r� <br /> CGRS <br /> T <br /> L <br /> SO U IONS DELIVERED REUFAVED <br /> 702 <br /> ENVIRONMENTAL iNT ALTH <br /> DEP <br /> GENERAL CONTRACTOR STATEMENT <br /> Effective 05/26/15,the State Water Resources Control Board now requires a signed statement from all <br /> general contractors prior to final ELD testing. <br /> By signing below,the general contractor acknowledges that: <br /> "No further ground penetrating work,including beautification requirements,atop or immediately <br /> adjacent to,the UST system are needed or will be performed after ELD testing is performed." <br /> General Contractor Information <br /> Company Name/CA License#: Wendt Construction <br /> Contact: Ken Wendt i <br /> Address: PO Box 1403, Lodi, CA 95241 <br /> Telephone/Email: 209-547-9310/ken@wendtandsons.com i <br /> Site Information <br /> Site Name; Arco <br /> I <br /> Address: 2056 Crestwood, Manteca,CA 95336 <br /> Telephone: unknown I <br /> County: San Joaquin <br /> I <br /> CUPA Contact: San Joaquin County Environmental Health <br /> I <br /> CUPA Phone/Email: ust@sjgov.org <br /> Testing Company Information <br /> Name: CGRS, Inc. <br /> Technician Assigned/License#: Sergio L. nez/#06-1727 <br /> Signature <br /> General Contr�".A-04 <br /> is Signature: <br /> I <br /> Name(prin _ `e <br /> Title: Date of Signature: <br /> I <br /> 5444 Dry Creek Rd. Sacramento,CA 95838 T9116-9911-1100 F 916-991-1177 www.cgrs.com <br /> I <br />