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CGRS <br />Vc O-UTIONS OQU% R6C <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 />ELO 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 #: Able Maintenance <br />Contact: Ryan Brownlee <br />Address: 3224 Regional Parkway, Santa Rosa, CA 95403 <br />Telephone/Email: 707-569-4791/ryan@ablemaintenance.com <br />Site Information <br />Site Name: <br />Safeway <br />Address: <br />2802 Country Club Blvd, Stockton, CA 95204 <br />Telephone: <br />unknown <br />County: <br />San Joaquin <br />CUPA Email: <br />ust@sjgov.org <br />Information <br />Name: CGRS, Inc. j <br />Technician Assigned/License M Richard Thomas/#06-1672 ] <br />Sia~nature <br />General Contractors Signature:~— <br />Name (print):•�^%� G __ <br />Title: -1 ?► Date of Signature: <br />5144 Dry Groep lid. Soleameft CA 9M 7916.991.1100 F 916.491.1111 www.og tax <br />