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REMOVAL_1999
Environmental Health - Public
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2300 - Underground Storage Tank Program
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PR0231117
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REMOVAL_1999
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Last modified
1/20/2021 2:52:03 PM
Creation date
11/5/2018 9:58:17 AM
Metadata
Fields
Template:
EHD - Public
ProgramCode
2300 - Underground Storage Tank Program
File Section
REMOVAL
FileName_PostFix
1999
RECORD_ID
PR0231117
PE
2381
FACILITY_ID
FA0004021
FACILITY_NAME
STOCKTON CITY TAXI CAB COMPANY
STREET_NUMBER
2085
Direction
E
STREET_NAME
FREMONT
STREET_TYPE
ST
City
STOCKTON
Zip
95205
APN
14111223
CURRENT_STATUS
02
SITE_LOCATION
2085 E FREMONT ST
P_LOCATION
01
P_DISTRICT
001
QC Status
Approved
Scanner
SJGOV\rtan
Supplemental fields
FilePath
\MIGRATIONS\F\FREMONT\2085\PR0231117\REMOVAL 1999.PDF
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EHD - Public
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PUBLIC HTALTH SERVICES <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DMSION <br /> Karen Furst,M.D., M.P.H., Health Officer " o•.� : <br /> �[%f •RN <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 /> I. 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 <br /> wells, buildings, underground public utility lines (including water, sanitary sewer and storm sewer), and <br /> distance of piping from tank to dispensers. If underground utilities are not included on the site map, you <br /> must state in writing that USA Dig will be contacted prior to excavation activities. <br /> �S[7' .//3. Complete page 3, "Application for Underground Storage Tank Closure Permit". Note: Sampling <br /> (� firm shall be an independent third parry from the contractor. <br /> ,K,,Z4. Complete page 9, "Authorization to Release". This form must be signed and dated by the <br /> OWNER/OPERATOR of the facility. <br /> K✓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- <br /> EHD) "Underground Storage Tank Disposition Tracking Record", except those requiring a signature <br /> and date of tank removal. The holder of the permit shall be responsible for ensuring that this form is <br /> completed and returned to PHS-EHD within 30 days of the tank removal. <br /> V 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 /> b4 <br /> V".-8. If facility is located outside of the city limits, submit a 'Backfill Excavation Certificate" as required by <br /> ` the County of San Joaquin Building Department and the incorporated City Building Departments, <br /> _ pursuant to the Uniform Building Code STD 70-11. <br /> t t� 9. Obtain a "Grading and Excavation Permit" from the City of Tracy Building Division prior to PH$- <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 S78.00/hour <br /> fee and the review will begin on the date of resubmittal. <br /> 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 10/19/98) Page I <br /> A Division of San Joaquin Counry Health Carr Scrvices <br />
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