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Q <br />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 #: Town & Country Contractors <br />Contact: Mark Farmer <br />Address: 3181 Luyung Dr. #A, Rancho Cordova, CA 95742 <br />Telephone/Email: 916-636-9500/mark@tccontractors.com <br />Site Information <br />Site Name: <br />Chevron <br />Address: <br />NEC International Pkwy & Daylight Rd., Tracy, CA 95377 <br />Telephone: <br />unknown <br />County: <br />San Joaquin <br />CUPA Contact: San Joaquin County Environmental Health <br />CUPA Email: ust@sjgov.org <br />Name (print): <br />Title:ez?? Date of Signature: 3�z <br />5444 Dry Creek Rd. Sacramento, CA 95838 T916-991-1100 F 916-991-1177 www.cgrs.com <br />