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ZGR5 <br />SOLUTIONS DELIVERED <br />GENERAL CONTRACTOR STATEMENT <br />:a,, 1 0 MxI <br />itd 'i ZM <br />ENVIRONMENTAL HEALTH <br />DEPARTMENT <br />Effective 05/26/15, the State Water Resources Control Board now requires a signed statement from all <br />general contractors prior to final ELD testing. <br />By signing below, the general contractor acknowledges that: <br />"No further ground penetrating work, including beautification requirements, atop or immediately <br />adjacent to, the UST system are needed or will be performed after ELD testing is performed." <br />General Contractor Information <br />Company Name/CA License #: B&T Service Station Contractors <br />Contact: Glenn Paredes <br />Address: 630 S. Frontage Rd., Nipomo, CA 93444 <br />Telephone/Email: 805-929-8944 ext 1002/glenn@btssc.com <br />Site Information <br />Site Name: Chevron <br />Address: 1231 North Main St., Manteca, CA 95336 <br />Telephone: unknown <br />County: San Joaquin <br />CUPA Contact: San Joaquin County Environmental Health <br />CUPA Phone/Email: ust@sjgov.org <br />Testing Company Information <br />Name: CGRS, Inc. <br />Technician Assigned/License #: Sergio L. Nunez/#06-1727 <br />Signature <br />General Contractor's Signature: �cQ-n4L <br />Name (print): Glenn Paredes <br />Title: Project Manager <br />5444 Dry Creek Rd, Sacramento, CA 95838 <br />Date of Signature: 2/25/2020 <br />T916.991-1100 F916-991.1177 www.cgrs,com <br />