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PUBLIG�HEALTH SER`�ICES °AA •Qpp <br /> SAN JOAQUIN COUNTY <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 /> CLOSURE IN PLACE <br /> Business/OwnefsName: POSDEF Power Company, L.P. <br /> Facility Address: 2526 W Washington Street Stockton CA licant's <br /> Tank(s)Number: 001----- Sweeps Number: Computer Number. TA957501 App <br /> Name: Ed Stock on Phone No: 467-7838 Date Submitted:—gjj-2f(19 <br /> ( ] 1. Local County/City Fire District shall approve the Closure in Place(CIP)prior to Environmental Health Division <br /> (PHS/EHD)approval. <br /> ( ] 2. A registered geologist or qualified consultant shall submit the CIP proposal. <br /> ( ] 3. The applicant shall complete the "Application for Permit to Close Underground Storage Tanks Storing <br /> Hazardous Materials"form and remit a$267 review fee. Any additional review time required will be assessed <br /> at$89 per hour. <br /> [ ] 4. The applicant shall submit a technical workplan which includes the details of the proposed construction: <br /> a) The reason for requesting a closure-in-place. <br /> b) History of the tank site: Previously and currently stored contents, tank capacity,tank location, any <br /> obstacle dictating boring locations,and any failed precision tests or unauthorized releases associated <br /> with the tank. <br /> C) Cross-sectional drawing of tank and proposed angle borings. (Indicate where the borings will <br /> terminate) <br /> d) A minimum of two borings and four soil samples per tank (Indicate where samples will be collected) <br /> C) A description of sampling protocol and types of analyses to be performed. (If water is encountered, <br /> a water sample shall also be collected) <br /> f) Provide this office with the minimum detection limits that will be utilized in the suggested analysis. <br /> g) Obtain an EPA identification number for hazardous waste that is generated on site. <br /> h) Provide a hazardous.waste manifest for any hazardous waste that is generated on site. <br /> i) Provide method for sealing the boring(s)and indicate sealing material to be utilized. <br /> [ ] 5. The applicant shall complete the "Application for Permit SJLHD" and remit S89 boring permit fee. <br /> a) An initial fee of$89 includes the first hour of inspection time.If additional inspection time is required, <br /> a$89 per hour fee will be assessed. <br /> b) The above application shall be signed by the licensed drilling contractor or his authorized agent. (This <br /> authorization shall be submitted in writing.) <br /> C) A separate and complete"Application for permit SJLHD"form and$89 permit fee is required for each <br /> separate parcel. <br /> d) The drilling contractor performing work must have on file: <br /> o A copy of the C-57 well driller's license. <br /> o A current copy of Worker's Compensation Insurance certificate. <br /> o A completed"Contractor's Questionnaire". <br /> [ ] 6. The applicant shall complete the "Authorization to Release Analytical Information" form and obtain the <br /> signature of the property owner or his authorized representative. <br /> [] 7. A notice to be placed on the deed of the property(describe exact vertical and areal location of the closed UST, <br /> the hazardous substances it contained,and the closure method). <br /> Approved Ay 'K o <br /> Dare: <br /> EH n 039(RI 8.1-01) A Division of San Joaquin County Health Care Semi= <br />