Laserfiche WebLink
BOARD OF TRUSTEES SAN JOAQUIN LOCAL HEALTH DISTRICT sER I G <br /> At Crow,Pres. ri ��J non Joaquin CountyEarl Plmentel,Vice Pres. 1601 East Hazelton Avenued� �4 L[ ,1City of Manteca <br /> Tommy Joyce,Secy. Stockton, California 95205 y.✓3 �• 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 1989 City of Ripon <br /> Thomas Schubert D.V.M. San Joaquin County <br /> Daphne Shaw City of Stockton <br /> Harvey Williams,Ph.D. '?rYJw1ENTAl-H'I-A�i n Joaquin County <br /> APPLICATION FOR PERMIT TO CLOSE `"-,SERVIC. <br /> UNDERGROUN S MATERIALS <br /> I. GENERAL INSTRUCTIONS: <br /> ❑ 1. Submit all information in triplicate. USE CARBONS. <br /> v.❑ 2. Include a detailed site map showing tank location and type, <br /> piping, streets and adjacent properties (north toward the <br /> top of thepage) location of nearby septic tanks, <br /> leachfields, buildings and underground public utility lines <br /> � (including water, sanitary sewer and storm sewer) . <br /> b 3. Complete form "APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br /> CLOSURE". <br /> P--4. Complete the "Authorization to Release Analytical Data" form. <br /> V5. Submit the appropriate fees and complete the "Underground <br /> Er-6. <br /> � Tank Program Fee Worksheet". <br /> E 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 /> do Zc c� <br /> �d ❑ 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 /> P'9. Compplete 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 /> X10. The maximum review time for Closure Plans is 15 working days <br /> from the date of receipt of the adequately completed Plan. <br /> 2 111. Advance inspection notice of at least 98 hours is re uired b <br /> L' eh San Jos ui-" all elfh District. propria e a vance <br /> ins on notification of iuris is ional fire ibis <br /> contractorresponsibility.sr <br /> EH 23 040 <br /> REVISED 12/88 <br /> Administration Clinical Services Environmental Health Public Health Nursing <br /> 468-3400 468-3830 468-3420 468-3600 <br /> Air Pollution Community Services Laboratory WIC <br /> 468-3470 466-3820 468-3460 468-3280 <br /> AIDS Information 468-3820 <br />