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REMOVAL_2016
EnvironmentalHealth
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EHD Program Facility Records by Street Name
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2300 - Underground Storage Tank Program
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PR0541462
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REMOVAL_2016
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Last modified
1/20/2022 10:02:31 AM
Creation date
1/20/2022 9:50:34 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
2016
RECORD_ID
PR0541462
PE
2361
FACILITY_ID
FA0023769
FACILITY_NAME
FAMILY RESIDENCE OF RODNEY D & LINDA D GAEDE
STREET_NUMBER
8476
Direction
E
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
CURRENT_STATUS
02
SITE_LOCATION
8476 E KETTLEMAN LN
QC Status
Approved
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SJGOV\kblackwell
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EHD - Public
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See `Sampling Protocol for Routine Tank Removals' and `Verification Analysis' on page <br />6 and 7 of the permit application for required analytical tests and number of samples to <br />be taken and witnessed by EHD. <br />A copy of the Fire Department permit must be submitted at the time of removal. <br />In addition, the following information must be submitted within 30 days after the UST <br />removal 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 (DISC 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 <br />is 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) 953-7311. <br />Thank you, <br />�_�Cd�n <br />.__ZV�_" <br />Fatinah Zareef, REHS <br />Senior Registered Environmental Health Specialist <br />Cc: Rodney D. Gaede and Linda D. Gaede. 8476 E. Kettleman Lane, Lodi, 95240 <br />Protecting Your Health -One Inspection at a Time <br />
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