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SITE INFORMATION AND CORRESPONDENCE FILE 2
Environmental Health - Public
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3500 - Local Oversight Program
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PR0544155
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SITE INFORMATION AND CORRESPONDENCE FILE 2
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Last modified
2/15/2019 2:31:10 PM
Creation date
2/15/2019 1:45:46 PM
Metadata
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Template:
EHD - Public
ProgramCode
3500 - Local Oversight Program
File Section
SITE INFORMATION AND CORRESPONDENCE
FileName_PostFix
FILE 2
RECORD_ID
PR0544155
PE
3526
FACILITY_ID
FA0000185
FACILITY_NAME
CITY GAS & LIQUOR
STREET_NUMBER
16470
STREET_NAME
CAMBRIDGE
STREET_TYPE
ST
City
LATHROP
Zip
95330
APN
19643032
CURRENT_STATUS
02
SITE_LOCATION
16470 CAMBRIDGE ST
P_LOCATION
07
P_DISTRICT
003
QC Status
Approved
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Circle K 16470 Cambridge Street, Lathrop <br /> SR0063858 <br /> 6. Any soil not returned to the tank pit must be manifested and be disposed at an approved <br /> disposal location. Soil returned to the tank pit will be evaluated to determine if additional <br /> remediation is required. Please contact EHD Site Mitigation inspector Mike Infurna at <br /> (209)468-3454. <br /> 7. It is highly recommended that any endangered wells in the immediate vicinity of <br /> excavation be removed prior to tank removal and be reinstalled when the tank removal is <br /> completed. Construction, alteration, or destruction of monitoring wells and exploration <br /> holes (borings) or shallow exploration holes (borings) installed to monitor hazardous <br /> waste facilities, or underground storage tanks, or land acquisitions, shall be performed <br /> by a C-57 licensed contractor under the direction of California Registered Professional <br /> Engineer, California Registered Geologist, or a California Certified Engineering <br /> Geologist, [section 6735, 7835 and 7835.1, Business and Professional code and Rule <br /> 415, Professional and Vocational Regulations]. A permit with SJC EHD must be issued <br /> prior to construction, alteration and destruction of the wells. <br /> 8. A copy of the submitted "Health and Safety Plan" must be on the jobsite for review. <br /> 9. See 'Sampling Protocol For Routine Tank Removals' and 'Verification Analysis' on page <br /> 6 and 7 of the permit application for required analytical tests and number of samples to <br /> be taken and witnessed by EHD. Please be aware UST piping shall not be removed until <br /> EHD has laid out the sampling points. <br /> 10. A copy of the Fire Department permit must be submitted at the time of removal. <br /> 11. In addition, the following information must be submitted within 30 days after the UST <br /> removal date: <br /> a. Only analytical results that come directly from a third party California certified <br /> laboratory with affixed chain of custody will be accepted by this EHD. <br /> b. UST Tracking Record Sheet and/or Tank Hazardous Waste Manifest. <br /> c. Tank Closure Certification Form (DTSC Form 1249) <br /> d. Hazardous Waste Manifest for rinsate, residual fuel, and ethylene glycol waste from <br /> the interstitial space. <br /> e. Submit the backfill excavation certificate as required by San Joaquin County <br /> 12. Permit expires 180 days from the date of approval. If an extension to the expiration date <br /> is required, a written request must be submitted to this office prior to the expiration date. <br /> If you have any further questions, please contact me at(209) 468-8257. <br /> Than ou, <br /> Thuy Tran, Sr. REHS <br /> Senior Registered Environmental Health Specialist <br /> CC: Ahmad Ghaderi/ Robert Velasco A&S Engineering Fax 661-250-9333 <br /> Michael Infurna SJC EHD— Site Mitigation Unit IV <br /> 2 <br />
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