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i <br /> >� - <br /> M <br /> CGRS <br /> All <br /> SOLUTIONS DELIVERED = <br /> Fill <br /> T !4 C? ALm <br /> 1 <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 4 : Walton Engineering <br /> Contact . Michael Walton <br /> Address : PO Box 1025, West Sacramento, CA 95691 <br /> Telephone/Email : 916 -372 - 1888/m . walton@waltonengineering . com <br /> Site Information <br /> Site Name : Chevron <br /> Address : 1490 S . Main St . , Manteca, CA 95337 <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 11 : Sergio L. Nunez/tt06- 1727 <br /> Signature <br /> General Contractor's Signature : <br /> Name ( print) : r` ► CIA oe6? .S, , V i2/V <br /> Title : 'ZO /' • Date of Signature . i,! <br /> 3/ C <br /> U&I Dry Creek Rd. Sacramento, CA 95838 T 916.991 . 1100 F 91091 1177 www.cgrs.com <br />