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� J <br /> -� CGRS <br /> SOLUTIONS DELIVERED <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 q: Gettler-Ryan Inc. <br /> Contact: Mike Carruth <br /> Address: 6805 Sierra Ct.hG, Dublin, CA 94568 <br /> Telephone/Email: 916-8S1-1830/mcarruth@grinc.com <br /> Site Information <br /> Site Name: Arco AM/PM <br /> Address: 800 E. Kettleman Ln,Lodi,CA 95240 <br /> Telephone: unknown <br /> County: San Joaquin <br /> CUPA Contact: San Joaquin County Environmental Health <br /> CUPA Phone/Email: ust@sjcehd.com <br /> Testing Company Information <br /> Name: CGRS,Inc. <br /> Technician Assigned/License a: Sergio L.Nunez/406-1727 <br /> Signature <br /> General Contractor's Sig <br /> I <br /> I <br /> Name(print): 1161ZAl�� <br /> / <br /> Title: <br /> G'(�Qtr�1iM v Date of Signature: <br /> 5441 Dry Creek Rd. Socromento,CA 95838 1916-991.1100 f 916-991.1177 www.cgmcom <br />