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SAN J O A Q U I N Environmental Health Department <br /> COUNTY <br /> 7 . See ` Sampling Protocol for Routine Tank Removals ' and 'Verification Analysis ' on page 6 and 7 <br /> of the permit application for required analytical tests and number of samples to be taken and <br /> 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 removal <br /> date : <br /> a . Analytical results : only results that come directly from a third party California certified <br /> 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 date is <br /> required , a written request must be submitted to this office prior to the expiration date . <br /> If you have any further questions , please contact me at (209 ) 468 -3440 . <br /> Thank you , <br /> Stacy Riv� <br /> Lead 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 /> 2of2 <br />