Laserfiche WebLink
PQuIN San Joaquin County <br /> ° ` ' � Environmental Health Department DIRECTOR <br /> Linda Turkatte , REHS <br /> 1868 E . Hazelton Avenue <br /> u): PROGRAM COORDINATORS <br /> Stockton , California 95205 =6232 Robert McClellon , REHS <br /> Jeff Carruesco , REHS , RDI <br /> cq�1 ��P Kasey Foley , REHS <br /> FOR Website : www ,sjgov . org/ehd <br /> 209 468 -3420 Rodney Estrada , RENS <br /> Phone : <br /> ( ) Willy Ng , REHS <br /> Fax : ( 209) 464-3433 <br /> APPLICATION FOR UNDERGROUND STORAGE TANK <br /> RETROFIT OR PIPING REPAIR PERMIT <br /> [ ] 1 . Submit all information in triplicate . Answer all questions , leaving no blanks . One copy will be returned to the <br /> applicant with comments . <br /> [ ] 2 . Include a detailed site map on a separate sheet of paper showing all work to be done . Include the location of <br /> the tanks ( s) , piping , all tank- related appurtenances , streets , adjacent properties ( north toward the top of the page) , <br /> nearby septic tanks , leachfields , water wells , buildings , underground public utility lines ( including water, sanitary <br /> sewer and storm sewer) , and distance of piping from tank to dispensers . If underground utilities are not included <br /> on the site map , you must state in writing that USA Dig will be contacted prior to excavation activities . <br /> [ ] 3 . Complete pages 3-6 , "APPLICATION FOR UNDERGROUND STORAGE TANK RETROFIT OR PIPING <br /> REPAIR PERMIT" . NOTE : If sampling is required , sampling firm shall be an independent third party from the <br /> contractor performing the work . <br /> [ ] 4 . Complete page 7 , "Authorization to Release" . This form must be signed and dated by the <br /> OWNER/OPERATOR of the facility . <br /> [ ] 5 . Submit a completed " Service Request" form and " Underground Storage Tank Program Fee Worksheet" . <br /> [ ] 6 . If performing any excavation activities , and the facility is located outside of the city limits , submit a " Backfill <br /> Excavation Certificate " as required by the San Joaquin County Building Department . If a " Backfill Excavation <br /> Certificate " is required by any incorporated areas ( cities ) , submit to the appropriate City Building Departments , <br /> pursuant to the Uniform Building Code STD 70- 11 . <br /> [ ] 7 . The maximum review time for Plan Review is 15 working days from receipt of the adequately completed plan . If <br /> gross deficiencies are identified , an addendum will be required with a $ 139 . 00 per hour fee and the review will <br /> begin on the date of resubmittal . <br /> [ ] 8 . Advance inspection notice of at least 48 hours is required by the Environmental Health <br /> Department ( EHD ) . <br /> [ ] 9 . Contractor to Provide : Combustible/Flammable gas detector (to verify the Lower Explosive Limit ( LEL) <br /> atmosphere and oxygen level ) , adequate number(s) and appropriate type (s ) of fire extinguisher( s ) , and barriers to <br /> secure the area as necessary to minimize traffic and pedestrian interference . It shall be the project manager' s <br /> responsibility for compliance with all health & safety regulations and requirements , including confined space <br /> requirements , which shall be strictly adhered to at all times during the course of the underground storage tank <br /> ( UST) activities . <br /> [ ] 10 . The EHD permit shall be on site during all UST permit- related activities . <br /> [ ] 11 . Any changes in this document shall be approved by the EHD prior to initiating work . All changes to any work <br /> must be described in detail on pages 3 & 4 and be shown on the detailed site map . <br /> EH230038 (revised 7-26-2016) 1 <br />