My WebLink
|
Help
|
About
|
Sign Out
Home
Browse
Search
REMOVAL_1998
Environmental Health - Public
>
EHD Program Facility Records by Street Name
>
K
>
KETTLEMAN
>
301
>
2300 - Underground Storage Tank Program
>
PR0231345
>
REMOVAL_1998
Metadata
Thumbnails
Annotations
Entry Properties
Last modified
9/1/2021 2:10:38 PM
Creation date
10/11/2018 2:12:08 PM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
1998
RECORD_ID
PR0231345
PE
2381
FACILITY_ID
FA0003713
FACILITY_NAME
CHEVRON #95775 MCCOMBS* (INACT)
STREET_NUMBER
301
Direction
W
STREET_NAME
KETTLEMAN
STREET_TYPE
LN
City
LODI
Zip
95240
APN
04514002
CURRENT_STATUS
02
SITE_LOCATION
301 W KETTLEMAN LN
P_LOCATION
02
P_DISTRICT
004
QC Status
Approved
Scanner
KBlackwell
Tags
EHD - Public
There are no annotations on this page.
Document management portal powered by Laserfiche WebLink 9 © 1998-2015
Laserfiche.
All rights reserved.
/
69
PDF
Print
Pages to print
Enter page numbers and/or page ranges separated by commas. For example, 1,3,5-12.
After downloading, print the document using a PDF reader (e.g. Adobe Reader).
View images
View plain text
HPALTHJETSPUBLIC . <br />SAN JOAQUIN COUNTY 2 <br />;;. <br />ENVIRONMENTAL HEALTH DIVISION <br />Karen Furst, M.D., M.P.H., Health Officer <br />304 East Weber Avenue, Third Floor • Stockton, CA 95202 <br />209/468-3420 <br />APPLICATION FOR PERMIT TO CLOSE <br />UNDERGROUND STORAGE TANKS STORING HAZARDOUS MATERIALS <br />GENERAL INSTRUCTIONS. <br />Submit all information in triplicate. Answer all questions, leaving no blanks. One copy will be returned <br />to the applicant with comments. <br />[ ] 2. Include a detailed site map on a separate sheet of paper, showing the location of the tanks(s), piping, <br />streets, adjacent properties (north toward the top of the page), nearby septic tanks, leachfields, water wells, <br />buildings, underground public utility lines (including water, sanitary sewer and storm sewer), and distance <br />of piping from tank to dispensers. If underground utilities are not included on the site map, you must state <br />in writing that USA Dig will be contacted prior to excavation activities. <br />[ ] 3. Complete page 3, "Application for Underground Storage Tank Closure Permit". <br />[ ] 4. Complete page 9, "Authorization to Release". This form must be signed and dated by the <br />OWNERIOPERATOR of the facility. <br />[ ] 5. Submit the appropriate fees 'and complete page 11, the "Underground Storage Tank Program Fee <br />Worksheet". <br />[ ] 6. Complete all questions on page 10, the Public Health Services -Environmental Health Division (PHS-EHD) <br />"Underground Storage Tank Disposition Tracking Record", except those requiring a signature and date <br />of tank removal. The holder of the permit shall be responsible for ensuring that this form is completed <br />and returned to PHS-EHD within 30 days of the tank removal. <br />[ ] 7. Submit a "Site Health & Safety Plan" as an addendum to this application, to address all potential <br />hazards for this specific job site. Refer to the Site Safety Plan Guidance Document for specifics. <br />[ ] 8. If facility is located outside of the city limits, submit a 'Backfill Excavation Certificate" as required <br />by the County of San Joaquin Building Department and the incorporated City Building Departments, <br />pursuant to the Uniform Building Code STD 70-11. <br />[ ] 9. Obtain a "Grading and Excavation Permit" from the City of Tracy Building Division prior to PHS- <br />EHD approval of the closure plan. <br />[ ] 10. The maximum review time for Closure Plans is 15 working days from receipt of the adequately <br />completed plan. If gross deficiencies are identified, an addendum will be required with a 578.00/hour fee <br />and the review will begin on the date of resubmittal. <br />[ ] 11. Submit verification of the fire permit from the appropriate fire district at the removal inspection. <br />[] 12. Advance inspection notice of at least 48 hours is required by PHS-EHD. <br />EH 23 046 (Revised 9/11/96) Page 1 <br />A Division of San Joaquin County Health Care Services <br />
The URL can be used to link to this page
Your browser does not support the video tag.