Laserfiche WebLink
1.01 C�r <br /> BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br /> AI Crow,Pres. San Joaquin County <br /> Ead Pimentel.Vice Pres. 1601 East Hazelton Avenue City of Manteca <br /> Tommy Joyce,Secy. Stockton,California 95205 C/ /P City of Escalon <br /> James F.Culbertson [ 1.�� ��f�� City of Lodi <br /> John 0.Mast,M.D. JOGI KHANNA, M.O., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br /> Virginia Mathews �/' / City of Ripon <br /> Thomas Schubert,D.V.M. -1 Omar <br /> San Joaquin County <br /> Daphne Shaw �-tJ f m L l City of Stockton <br /> Harvey Williams,PhD. San Joaquin County <br /> APPLICATION FOR PERMIT TO CLOSE <br /> UNDERQ20UN S S I� <br /> GENERAL INSTRUCTIONS: <br /> Submit all information in triplicate. USE CARBONS. <br /> Include a detailed site map showing tank location and type LTH <br /> piping, streets and adjacent properties (north toward the <br /> top of the page) location of nearby septic tanksi <br /> leachfields, ui dings and underground public utility lines <br /> (including water saniLry�^sewer and storm sewer) . <br /> l� 3. Com Tete Eo m�' PLIC1 TI"R(PERMIT FOR UNDERGROUND TANK <br /> mplTette t e,Arut��t*oon to eleaseQ licaall�Da-t�a"form. <br /> �1 Submit thhe appropria es and comp ete the �! end rground <br /> OI � / Tank Program Fee Worksheet". <br /> W�6. Procedures should explain decontamination techniques if <br /> mlicable, materials) utilized for rinsate, transportation <br /> /or storage of hazardous waste generated on site, and <br /> specify the responsible party(ies) who will be disposing of <br /> waste generated on site. <br /> 7 Procedures should explain purging and/or inerting method. <br /> 8. Describe in detail how soil and/or water samples beneath the <br /> tank's invert will be obtained. Refer to "Sampling Protocol <br /> for Routine Tank Removals" for sampling criteria. <br /> SY Comp <br /> 9. lete the San Joaquin Local Health District's (SJLHD) <br /> "Underground Tank Disposition Tracking Record". The holder <br /> of the permit shall be responsible for ensuring that this form <br /> is completed and returned the SJLHD. <br /> O 10. The maximum review time for Closure Plans is 15 working days <br /> from the date of receipt of the adequately completed Plan. <br /> l] 11 Advance ins -tion notice of at least 98 hours is re fired b <br /> L e an oawin oca ea is ric ro ria g a vance <br /> inspec ion noti ca ion o Jurisdictional- ire is�I is <br /> contractor s rasoonsJD111 v <br /> EH 23 040 <br /> REVISED 12/88 <br /> F�Dz(J�uh/CP ltj Guy �wn fr.�.,c� v� o6i s��,�rra-eh" � <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-8400 468-3830 468-3420 468-3960 <br /> Air Pollution Community Services Laboratory yylC <br /> 468-3470 466-3820 468-3460 468-3280 <br /> AIDS information 468-3820 <br />