Laserfiche WebLink
BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT SERVING <br />Al Crow, Pres. San Joaquin County <br />Earl Pimentel, Vice Pres. 1601 East Hazelton Avenue City of Manteca <br />Tommy Joyce, Secy. Stockton, California 95205 City of Escalon <br />James F. Culbertson City of Lodi <br />John D. Mast M.D. JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Tracy <br />Virginia Mathews City of Ripon <br />Thomas Schubert D.V.M. San Joaquin County <br />Daphne Shaw City of Stockton <br />Harvey Williams, Ph.D. San Joaquin County <br />APPLICATION FOR PERMIT TO CLOSE <br />UNDERGROUND STORAGE TANKS STORING HAZARDOUS MATERIALS <br />I. GENERAL INSTRUCTIONS: <br />26. 1. Submit all information in triplicate. USE CARBONS. <br />L7 2. Include a detailed site map showing tank location and type, <br />piping, streets and adjacent properties (north toward the <br />top of the page), location of nearby septic tanks, <br />leachfields, buildings, and underground public utility lines <br />(including water, sanitary sewer and storm sewer). <br />LTJ 3. Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br />CLOSURE". <br />L7 4. Complete the "Authorization to Release Analytical Data" form. <br />ET"5. Submit the appropriate fees and complete the "Underground <br />,✓ Tank Program Fee Worksheet". <br />LST 6. Procedures should explain decontamination techniques if <br />applicable, material(s) utilized for rinsate, transportation <br />and/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 />07 7. 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 />2' 8. Complete 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 />❑ 9. Advance inspection notice of at least 48 hours is required by <br />the San Joaquin Local Health District. Appropriate advance <br />inspection notification of jurisdictional fire district is <br />contractor's responsibility_ <br />EH 23 040 <br />REVISED 12/88 <br />Administration <br />Clinical Services <br />Environmental Health <br />Public Health Nursing <br />468-3400 <br />468-3830 <br />468-3420 <br />468-3860 <br />Air Pollution <br />Community Services <br />laboratory <br />WIC <br />468-3470 <br />468-3820 <br />468-3460 <br />468-3280 <br />AIDS Information 468-3820 <br />