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CGRS <br /> SOLUTIONS DELIVERED <br /> GENERAL CONTRACTOR STATEMENT <br /> Effective 05/26/15,the State Water Resources Control Board requires that the signed general <br /> contractor's statement be received from all general contractors prior to formal notification of final <br /> ELD testing (NO EXCEPTIONS). <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 Contractor License#: Gettler-Ryan <br /> Contact: Kelvin Cruz <br /> Address: 6805 Sierra Ct.#G, Dublin, CA 94568 <br /> Telephone/Email: 925-551-7444/kcruz@grinc.com <br /> Site Information <br /> Site Name: Arco <br /> Address: 2459 E. Mariposa Rd.,Stockton,CA 95205 <br /> Telephone: unknown <br /> County: San Joaquin <br /> CUPA Contact: San Joaquin Cty Env. Health <br /> ust@sjgov.org <br /> CUPA Phone/Email: <br /> Testing Company Information <br /> Name: CGRS, Inc. <br /> Technician Assigned/License#: Sergio L. Nunez/#06-1727 <br /> Signature <br /> General Contractor's Signature: <br /> Name(print): I -)V-MN3 Ib 1 � <br /> Title: , Date of Signature: _ <br /> 5444 Dry Creek Rd. Sacramento,CA 95838 T 916.991.1100 F 916.991.1177 www.cgrs.com <br />