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4F-i2' CGRS <br /> SOLUTiONM DELWERED <br /> GENERAL CONTRACTOR STATEMENT <br /> Effective 05/26/1%the State Water R-Psources Control Board requires that the signed general <br /> wntractor`s statement be received(ram all general contractors prior to format nu"i ation of final <br /> ELD testing ({yip EKCEPTrONS}. <br /> By Siyninj3 below,the general contractor a€kn owl edges that. <br /> "No further grovnd penetrating work,incruding beau tlFcatimi requirernints,atop or immediately <br /> adjacent to,the UST system are needed or will be performed after ELD testing is performed-" <br /> General Contractor rnformation <br /> Company Name/CA Contrartor Li€ense tJ: Able. Maintenance <br /> ConCact' Shea Fuller <br /> Address: 3224 Regional Parkway, Santa Rosa, CA 95403 <br /> Telephone/Email: 707-569-4791/Shea.Fuller@abicmaintenance.com <br /> Site information <br /> Site Naive; Tracy Triangle fueling <br /> Address. 3788 N Tracy Blvd,Tracy,CA <br /> Telephone: unknown <br /> County; San Joaquin <br /> CUPA Email: u5t9sjgov,arg <br /> Testing Company Information <br /> (dame,. CGRS, Inc. <br /> Technician Assigned/License P+; Adam Montejanofi01775 <br /> Signature <br /> General Contractor's Signature: <br /> #dame I print}; -Sli ie r" <br /> Title; 1e'+ t Date of Signature; <br /> Sew Dq No Rd. Sco rvme*,CA9M T916-991-1104 F 916-991 1177 www.om.com <br />