Laserfiche WebLink
�' <br /> i . <br /> i BOARD OF TRUSTEES - co/J// <br /> At Crow,Pres. SAN JOAOUIN LOCAL HEALTH DISTRICT <br /> Earl Pimentel,Vice Pres. <br /> TOMMY Joyce,Sec'y. 1601 East Hazelton Avenue SERVING <br /> James F.Culbertson Stockton, California 95205 San Joaquin County <br /> John D.Meal,M.D. City of Manteca <br /> Virginia Mathews JOGI KHANNA, M.D., M.P.H., DISTRICT HEALTH OFFICER City of Escalo <br /> Thomas Schubert D.V.M. City of Lodi <br /> Daphne Shaw �� /' City of Tracy <br /> Harvey Williams,Ph.D. /'� City of Ripon <br /> '/SZ 7 'ryL�/ 2v San Joaquin County <br /> APPLICATION FOR p � City of Stockton <br /> UNDER 0 ERMIT TO CLOSE San Joaquin County <br /> I S MATERIALS <br /> �ERAL INSTRUCi'IONS; <br /> 1 Submit all information in triplicate. USE CARBONS <br /> '� 1• Include a detailed <br /> opincl, streets andsadjacentsproper tank location ype <br /> p off the page? location ofpnearbylsepticrtanksward the <br /> (including underground public unlit <br /> / (includin <br /> 3• Complete „ y sewer and storm sewer) , y lines <br /> �OSURE" form APPLICATION FOR PERMIT FOR UNDERGROUND TANK <br /> mplete the "Authorization to Release Analytical Data form. <br /> Submit the appropriate fees and complete the <br /> Worksheet". "Underground <br /> _1k Program Fee Worksh <br /> Procedures should Blain decontamination techniques if <br /> and/or�storagetof <br /> material for rinsate, transportation <br /> specify the responsible party(ies)genera ed be disposing of <br /> / waste generated on site. <br /> �'7 rocedures should explain purging and/or inerting method. <br /> Describe in detail how soil and/or water samples <br /> tank 's invert will be obtained. Refer to "Samplingt�Protocol <br /> �orpRoutine Tank Removals" for sampling criteria. <br /> Cowete theund Tank Joaquin <br /> D quin Local Health District's (SJLHD) <br /> of the ?ermit shall. be res ensuriing that holder <br /> is comp_eced 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 /> ❑ 11. Advance ins action notice of at least 48 hours is re uired b <br /> L e an oa uta ocaITAea is rtc . <br /> ins ec ion no t tca ion o _ ]urts tc tons trc rts .rtc vis'-nee <br /> con rac or s res nst t 1 v <br /> EH 23 040 <br /> REVISED 12/88 <br /> Administration Clinical Services Environmental Healtht <br /> Public Health Nursing <br /> 468-3400 468-9030 <br /> 468.3420 468-3960 <br /> Au Pollution Community Services Laboratory WIC <br /> 468.3470 460-3820 468-3460 468-3280 <br />